Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 41, Issue 5
Displaying 1-10 of 10 articles from this issue
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Original Articles
  • Differential Effects of Activity and Climate on Onset of Subarachnoid Hemorrhage
    Kensuke KAWAI, Koichi NONAKA, Hiromasa SUZUKI, Takaaki KIRINO, Akira T ...
    2001 Volume 41 Issue 5 Pages 229-237
    Published: 2001
    Released on J-STAGE: July 01, 2005
    DOIhttps://doi.org/10.2176/nmc.41.229
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    Conflicting findings of the effect of climate on onset of subarachnoid hemorrhage (SAH) may result from the influence of strenuous activities which can trigger aneurysmal rupture independent of climatological factors. The effect of climate and patient activities on onset of SAH were analyzed. The clinical records of 786 consecutive patients with aneurysmal SAH admitted to our hospital for 10 years were reviewed. Activities at onset were categorized according to the intensity of strain at onset. Seasonal variation, circannual cyclic trend, and association with 90 meteorological factors were examined in each category and the results were compared between categories. Bimonthly occurrence in the light strain group showed a significant seasonal variation and cyclic trend with two peaks in early spring and fall, whereas no significant trend was detected in the overall patients and in the heavy strain group. The significant meteorological factors were global solar radiation, sunshine hours, changes in mean and minimum temperature and mean vapor pressure from the previous day, and minimum pressure in the previous 7 days. Lower global solar radiation in the light strain group was associated with onset with the lowest p value (p = 0.0046). No factors were significant in the heavy strain group. There is some evidence of the possible influence of climatological factors on onset of SAH without strenuous activity. Strenuous activity seems to affect onset more strongly, which masks any effect of climate.
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  • Inhibitory Effects of Verapamil and Nitroglycerin on Contraction and Cytosolic Ca2+ Levels in Cerebrovascular Smooth Muscle During Chronic Cerebral Vasospasm
    Yuichi TANAKA, Toshio MASUZAWA, Mitsuru SAITO, Takeshi YAMADA
    2001 Volume 41 Issue 5 Pages 238-245
    Published: 2001
    Released on J-STAGE: July 01, 2005
    DOIhttps://doi.org/10.2176/nmc.41.238
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    The mechanisms of the inhibitory effects of verapamil and nitroglycerin on vasospasm were investigated by measuring cytosolic Ca2+ level ([Ca2+]i) and muscle tension in 28 normal specimens and 28 spastic vascular specimens of smooth muscle. Experimental vasospasm was produced by the two-hemorrhage method in the canine basilar artery. [Ca2+]i and tension were recorded simultaneously with a fluorimeter using fura-2. High K+ concentration (72.4 mM) and U-46619 (thromboxane A2 analogue, 10-8 M) were used as stimulants, and the inhibitory effects of verapamil or nitroglycerin on muscle contraction and increased [Ca2+]i were examined. Verapamil inhibited [Ca2+]i and contraction in high K+ concentration-stimulated arteries. Verapamil inhibited [Ca2+]i more strongly than contraction in U-46619-stimulated arteries. There were no significant differences in the effects of verapamil in the control and vasospasm groups. Nitroglycerin inhibited contraction with little effect on [Ca2+]i in high K+ concentration-stimulated arteries in both the control and vasospasm groups. Nitroglycerin inhibited contraction with little effect on [Ca2+]i in U-46619-stimulated arteries and the inhibitory effect was weaker in the vasospasm group than in the control group. The inhibitory effects of verapamil on muscle tension and [Ca2+]i in vasospastic vessels were as strong as those in normal vessels. In contrast, the inhibitory effects of nitroglycerin were reduced in vasospastic vessels. Increased Ca2+ sensitivity in vasospastic vessels may have reduced the inhibitory effects of nitroglycerin.
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  • Surgical Treatment of Hemangioblastomas With Presurgical Endovascular Embolization
    Shigekazu TAKEUCHI, Ryuichi TANAKA, Yukihiko FUJII, Hiroshi ABE, Yasus ...
    2001 Volume 41 Issue 5 Pages 246-252
    Published: 2001
    Released on J-STAGE: July 01, 2005
    DOIhttps://doi.org/10.2176/nmc.41.246
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    The usefulness of presurgical embolization of hemangioblastomas was evaluated retrospectively in eight of 30 operations performed on eight of 27 consecutive patients with histologically verified hemangioblastoma. All tumors had over 3.5 cm maximum diameter of the solid mass. Presurgical embolization achieved 100% embolization in one case, 95% to 80% in two, 70% to 50% in two, and less than 50% in three. Total obliteration was obtained only in one case with a single feeding artery. No permanent neurological deficits developed after embolization, but cerebellar infarction occurred in one patient. The surgery was definitely easier than expected in three cases with 80% or more obliteration of tumors. Tumor swelling and cerebellar hematoma occurred during operation in one case with 70% tumor embolization and another case with less than 50%. Blood transfusion during operation was carried out in two cases with less than 50% tumor embolization. The clinical outcome was good recovery in one case, moderate disability in five, and severe disability in two. The reasons for residual neurological deficits were operation and meningitis in one patient, operative and preoperative symptoms in two, and residual preoperative symptoms in four. Neurological deterioration after surgery occurred in three patients with tumor embolization of less than 50%. Partial embolization of hemangioblastomas does not reduce operative complications or morbidity, unless almost complete embolization is achieved, which is not so easy.
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  • Participation of Thrombospondin-1 in the Activation of Latent Transforming Growth Factor-β in Malignant Glioma Cells
    Atsushi SASAKI, Hirofumi NAGANUMA, Eiji SATOH, Tomoyuki KAWATAKI, Keni ...
    2001 Volume 41 Issue 5 Pages 253-259
    Published: 2001
    Released on J-STAGE: July 01, 2005
    DOIhttps://doi.org/10.2176/nmc.41.253
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    Malignant glioma cells secrete transforming growth factor-β (TGF-β) and can activate latent TGF-β. However, the mechanism of the latent TGF-β activation has not yet been determined. This study examined whether thrombospondin-1 (TSP-1) secreted by malignant glioma cell lines participates in the activation of latent TGF-β secreted by the glioma cells. Western blot analysis revealed that TSP-1 was present in both the cell lysates and the culture supernatants of all three malignant glioma cell lines (T98G, A172, and U251). A bioassay for TGF-β activity revealed that all malignant glioma cell lines used in this study could activate latent TGF-β by themselves. Latent TGF-β1 activation, evaluated by enzyme-linked immunosorbent assay, was inhibited by more than 50% by the addition of neutralizing anti-TSP-1 monoclonal antibody or anti-TSP-1 polyclonal antibody. These results indicate that TSP-1 has a predominant role in the activation of latent TGF-β in malignant glioma cells.
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Case Reports
  • Ruptured Intracranial Aneurysm Associated With Unruptured Abdominal Aortic Aneurysm
    —Case Report—
    Hideki KANAI, Masanari UMEZU, Kazuo KOIDE, Motoki HATO
    2001 Volume 41 Issue 5 Pages 260-263
    Published: 2001
    Released on J-STAGE: July 01, 2005
    DOIhttps://doi.org/10.2176/nmc.41.260
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    A 61-year-old male with hypertension presented with sudden onset of headache and nausea due to subarachnoid hemorrhage (SAH). He had two siblings with history of SAH due to ruptured intracranial aneurysms. Right carotid angiography on admission showed an anterior communicating artery aneurysm. At that time, the extracranial arteries were not examined. The aneurysm was clipped with no complications. A pulsating mass was palpable in the abdomen 37 days after the onset. Ultrasonography and computed tomography showed an abdominal aortic aneurysm with intraluminal thrombus, measuring 8 × 9 × 8 cm. Normal pressure hydrocephalus had already developed. The patient underwent elective abdominal aortic aneurysm resection before ventriculoperitoneal shunting. After shunting, he recovered fully. The present case indicates that unpredictable sudden enlargement of associated abdominal aortic aneurysm is possible in patients with ruptured intracranial aneurysms.
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  • “Early” Apoplexy Due to Traumatic Intracranial Aneurysm
    —Case Report—
    Masaki KOMIYAMA, Toshie MORIKAWA, Hideki NAKAJIMA, Toshihiro YASUI, Ma ...
    2001 Volume 41 Issue 5 Pages 264-270
    Published: 2001
    Released on J-STAGE: July 01, 2005
    DOIhttps://doi.org/10.2176/nmc.41.264
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    A 76-year-old man presented with a traumatic aneurysm of the left internal carotid artery which caused repeated subarachnoid hemorrhages within 20 hours of a fall from a height. Early computed tomography (CT) detected no brain abnormalities, but repeat CT found subarachnoid hemorrhage. Internal carotid angiography detected a pseudoaneurysm, which was not treated because of his poor clinical condition. He died of multiple organ failure. Early detection of a traumatic intracranial aneurysm is important for the prevention of aneurysmal rupture, or “delayed” apoplexy. Review of 171 cases with traumatic aneurysms from the literature found that false negative angiography occurred only in three cases on post-trauma day 7 and thereafter. Early diagnostic angiography within a week of the initial trauma is indicated if traumatic aneurysm is suspected to detect early signs of irregularity, spasm, and narrowing of the arterial wall. Repeat angiography is indicated if aneurysmal formation is still highly suspected in spite of negative initial angiography.
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  • Dissecting Aneurysms at the A1 Segment of the Anterior Cerebral Artery
    —Two Case Reports—
    Jun HIRAO, Hisayo OKAMOTO, Takashi WATANABE, Shuichiro ASANO, Akira TE ...
    2001 Volume 41 Issue 5 Pages 271-278
    Published: 2001
    Released on J-STAGE: July 01, 2005
    DOIhttps://doi.org/10.2176/nmc.41.271
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    Two rare cases of dissections which involve the anterior cerebral artery (ACA) are reported. A 58-year-old woman presented with a ruptured dissecting aneurysm manifesting as sudden onset of severe headache and consciousness disturbance followed by aphasia, right hemiparesis, paresis of the left lower extremity, and choreoathetotic movements of the upper arms and face. Computed tomography and angiography revealed subarachnoid hemorrhage due to a dissecting aneurysm at the left A1 segment. The dissecting aneurysm was trapped surgically on the day of onset. Her neurological deficits disappeared within a month. A 39-year-old woman experienced continuous dull headache from the day before onset, and then suffered right hemiparesis. Magnetic resonance (MR) imaging revealed cerebral infarction at the left globus pallidus. Angiography and MR imaging revealed a dissecting aneurysm at the left A1 segment and occlusion of the left Heubner's artery. She received conservative treatment and her neurological findings were improved. Dissections or dissecting aneurysms involving the ACA can be classified into three types: Extension of a dissection to the ACA from the internal carotid artery, dissection at the A1 segment, and dissection at the A2-A4 segments. These types of dissection have distinct uniform clinical features.
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  • Neuroradiological Features of Intraosseous Cavernous Hemangioma
    —Case Report—
    Yasuhiro SUZUKI, Hisato IKEDA, Kiyoshi MATSUMOTO
    2001 Volume 41 Issue 5 Pages 279-282
    Published: 2001
    Released on J-STAGE: July 01, 2005
    DOIhttps://doi.org/10.2176/nmc.41.279
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    A 40-year-old man presented to our hospital because of a painless lump on his right forehead. Radiography showed a radiolucent defect in the frontal bone. Bone window computed tomography demonstrated a lucent mass which expanded externally from the diploë destroying and passing through the outer plate. T1-weighted magnetic resonance imaging revealed the lesion as non-homogeneously isointense, and T2-weighted imaging as non-homogeneously hyperintense. The lesion was enhanced non-homogeneously after contrast administration. The lesion was subtotally removed. Histological examination suggested cavernous hemangioma. Preoperative examinations could not provide a definitive diagnosis, which was established by the operative finding. Because of the difficulty of diagnosis in the early stage, surgical treatment in the early stage is recommended for total removal and definitive diagnosis of intraosseous tumor.
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  • Large Cholesterol Granuloma Arising From the Frontal Sinus
    —Case Report—
    Hidenobu OCHIAI, Yuzo YAMAKAWA, Tsuyoshi FUKUSHIMA, Shinichi NAKANO, S ...
    2001 Volume 41 Issue 5 Pages 283-287
    Published: 2001
    Released on J-STAGE: July 01, 2005
    DOIhttps://doi.org/10.2176/nmc.41.283
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    A 59-year-old male presented with a large cholesterol granuloma arising from the frontal sinus manifesting as a large, fluctuated, soft mass in his brow, compressing left eye. Skull radiography showed dilation of the frontal sinus. Computed tomography and magnetic resonance imaging revealed a cystic mass extending into the left orbit and anterior cranial fossa. Gross inspection at the frontal craniotomy showed mucinous, dark green fluid intermingled with shining material. The histological diagnosis was cholesterol granuloma with epithelial lining. Large cholesterol granuloma with facial deformity is always associated with bone and cosmetic problems. Wide opening of the frontal sinus followed by cyst wall removal and plastic repair of the skull is necessary.
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  • Sacral Meningeal Cyst Associated With Valve-like Mechanism
    —Case Report—
    Kazuya UEMURA, Yoji KOMATSU, Tomoyuki SHIBATA, Eiki KOBAYASHI, Tadao N ...
    2001 Volume 41 Issue 5 Pages 288-291
    Published: 2001
    Released on J-STAGE: July 01, 2005
    DOIhttps://doi.org/10.2176/nmc.41.288
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    A 58-year-old woman presented with low back pain radiating to the lower extremities. Magnetic resonance imaging revealed a cystic lesion in the sacrum compressing the nerve roots. At operation, a valve-like communication was found between the subarachnoid space and the cyst cavity in the vicinity of the sacral nerve root. The communication was obliterated with a purse-string suture and reinforced with a free muscle graft. Postoperatively, she reported improvement of the pain. Valve-like communication between the cyst cavity and subarachnoid space can cause enlargement of spinal meningeal cyst, and could also explain enlargement of sacral meningeal cyst. Surgical obliteration of the communication rather than the cyst resection is more important for sacral meningeal cyst.
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