Neurologia medico-chirurgica

Original Articles

Spatial Functional Distribution in the Corticospinal Tract at the Corona Radiata: A Three-dimensional Anisotropy Contrast Study

Takashi INOUE, Hiroaki SHIMIZU, Takashi YOSHIMOTO, Hiroyuki KABASAWA

2001 Volume 41 Issue 6 Pages 293-299
Published: 2001
Released on J-STAGE: July 01, 2005

DOIhttps://doi.org/10.2176/nmc.41.293

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The spatial functional distribution of the nerve fibers was investigated in the corticospinal tract at the level of the corona radiata. Thirteen patients with corona radiata infarction underwent axial single-shot echo planar diffusion-weighted magnetic resonance imaging using a 1.5 Tesla scanner. Image analysis used the three-dimensional anisotropy contrast (3DAC) method to demarcate the nerve fibers in the corticospinal tract. Axial 3DAC images demonstrated the corticospinal tract as a distinct area indicating nerve fiber integrity in all normal hemispheres and infarction as a dark or black area in affected hemispheres. Seven patients with upper extremity-dominant motor dysfunction had infarction located in the middle one third of the corticospinal tract. A patient with lower extremity-dominant motor dysfunction had infarction in the posterior one third. Five patients with equal motor dysfunction in the upper and lower extremities had infarction in both the middle and posterior one thirds of the corticospinal tract. The recovery of motor dysfunction at one month follow up correlated with the location of the corticospinal tract injury on the initial 3DAC images. The findings of the 3DAC images provide an indicator of the pattern and the recovery from acute and chronic motor dysfunction in patients with corona radiata infarction.

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Involvement of Fluctuating High Blood Pressure in the Enlargement of Spontaneous Intracerebral Hematoma

Masaharu MARUISHI, Takeshi SHIMA, Yoshikazu OKADA, Masahiro NISHIDA, K ...

2001 Volume 41 Issue 6 Pages 300-305
Published: 2001
Released on J-STAGE: July 01, 2005

DOIhttps://doi.org/10.2176/nmc.41.300

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The correlations between changes in blood pressure after admission and hematoma expansion were investigated in 118 patients with spontaneous intracerebral hematoma admitted within 24 hours of onset who underwent serial computed tomography. Multiple logistic regression was performed to assess correlations between hematoma enlargement and clinical characteristics on admission. Hematoma enlargement was predominantly correlated with time of onset (p = 0.01567), and not well correlated with blood pressure at admission (p = 0.07908). Serial changes in blood pressure were investigated in 57 patients admitted within 6 hours of ictus whose blood pressures were monitored every hour from admission. Wilcoxon signed-rank analysis was used to determine the relationships between hematoma enlargement and blood pressure. Patients with hematoma enlargement was significantly correlated with increased blood pressure (p = 0.0004). Increases in blood pressure after admission may be a factor in hematoma enlargement.

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Case Reports

Delayed, Transient Neurological Deterioration After Mild Head Injury

—Case Report—

Eiichirou URASAKI, Hideoki YASUKOUCHI, Akira YOKOTA, Yoshihiro ARAGAKI

2001 Volume 41 Issue 6 Pages 306-312
Published: 2001
Released on J-STAGE: July 01, 2005

DOIhttps://doi.org/10.2176/nmc.41.306

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A 16-year-old boy presented with delayed, transient neurological deterioration 18 days after mild head injury. Left hemiparesis and left homonymous hemianopsia appeared after right frontal contusional and mild subdural hematomas subsided. Neuroimaging examinations including cerebral angiography, magnetic resonance imaging, and single photon emission computed tomography showed vasodilation and hyperemia in the right cerebral hemisphere. The present case is not typical of acute “juvenile head trauma syndrome,” but may represent a possible pathophysiology of the delayed type of transient neurological deterioration after mild head injury.

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Spontaneous Cerebrospinal Fluid Rhinorrhea Associated With Chronic Renal Failure

—Case Report—

M. Faik OZVEREN, Metin KAPLAN, Cahide TOPSAKAL, Turgay BILGE, Fatih S. ...

2001 Volume 41 Issue 6 Pages 313-317
Published: 2001
Released on J-STAGE: July 01, 2005

DOIhttps://doi.org/10.2176/nmc.41.313

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A 39-year-old woman was admitted with complaints of headache and nasal discharge on the left for 3 months which was later on proved to be cerebrospinal fluid (CSF). Neurological examination found no abnormalities except bilateral papilledema. Neuroimaging demonstrated enlargement of the lamina cribrosa foramina through which the olfactory nerves pass, as well as empty sella and cerebral cortical atrophy. Bone mineral densitometry showed osteopenia. CSF Ca⁺⁺ and blood parathyroid hormone levels were elevated. CSF pressure was 280 mmH₂O. Bilateral frontal craniotomy was performed to expose the anterior fossa. Foraminal enlargement at the lamina cribrosa was confirmed, and islands of extra-osseous calcifications on the arachnoid membrane were identified. The base of the anterior fossa was repaired intradurally with fascial graft and fibrin glue on both sides. No CSF leakage was noted at 1-year follow up. Spontaneous CSF leakage probably resulted from enlargement of the foramina at the lamina cribrosa due to Ca⁺⁺ mobilization from bones and pseudotumor cerebri not to the extent of hydrocephalus caused by poor CSF absorption at the arachnoid granulations obliterated by extra-osseous calcareous accumulation.

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Spinal Extradural Arachnoid Cyst

—Case Report—

Shizuo HATASHITA, Akihide KONDO, Takashi SHIMIZU, Akihiro KUROSU, Hide ...

2001 Volume 41 Issue 6 Pages 318-321
Published: 2001
Released on J-STAGE: July 01, 2005

DOIhttps://doi.org/10.2176/nmc.41.318

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A 48-year-old male presented with progressive leg weakness. Magnetic resonance imaging and computed tomography myelography showed an extradural arachnoid cyst extending from the T-12 to L-2 levels in the thoracolumbar region. The cyst was confirmed at surgery and completely removed. This surgical intervention achieved improvement in the neurological symptoms.

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Cervical Myelopathy Due to Compression by Bilateral Vertebral Arteries

—Case Report—

Yoshihiko TAKAHASHI, Shunsuke SUGITA, Hisaaki UCHIKADO, Tomoya MIYAGI, ...

2001 Volume 41 Issue 6 Pages 322-324
Published: 2001
Released on J-STAGE: July 01, 2005

DOIhttps://doi.org/10.2176/nmc.41.322

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A 69-year-old man presented with progressive cervical myelopathy due to vascular compression of the upper cervical spinal cord. Vertebral angiography and magnetic resonance imaging revealed that the elongated bilateral vertebral arteries (VAs) had compressed the spinal cord at the C-2 level. The spinal cord was surgically decompressed laterally by retracting the VAs with Gore-Tex tape and anchoring them to the dura. The patient's symptoms improved postoperatively. Decompression and anchoring of the causative vessels is recommended due to the large size of the VAs.

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Two-Staged Operation for Thoracolumbar Osteomyelitis Following Methicillin-Resistant Staphylococcus Aureus Infection of a Craniectomy Wound

—Case Report—

Takahisa YAMADA, Junichi MIZUNO, Yasuhiro MATSUSHITA, Hiroshi NAKAGAWA

2001 Volume 41 Issue 6 Pages 325-329
Published: 2001
Released on J-STAGE: July 01, 2005

DOIhttps://doi.org/10.2176/nmc.41.325

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A previously healthy 53-year-old woman developed pyogenic vertebral osteomyelitis (PVO) manifesting as progressive lumbago following wound infection of a decompressive craniectomy performed for brain contusion caused by a traffic accident. Magnetic resonance imaging disclosed vertebral osteomyelitis at T-12 and L-1 with paravertebral abscess. Anterior debridement and fusion using autografts were performed at the first operation. Methicillin-resistant Staphylococcus aureus (MRSA) was cultured from the abscess specimen. Antibiotic therapy resolved the infection. Pedicle screw fixation was performed at the second operation. The patient became free from back pain and no recurrence of infection was seen. The diagnosis of PVO is frequently observed or delayed because of the nonspecific symptomatic presentation in the early stage. Coexistent infection or trauma makes early diagnosis more difficult. Indications and timing of instrumentation for the spinal column infected with MRSA is difficult. Two-staged operation with anterior debridement and posterior instrumentation after eradication of the infection is a safe and effective procedure for MRSA vertebral osteomyelitis.

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Technical Note

Surgeon's Position for Transsphenoidal Surgery

—Technical Note—

Youichi SAITOH, Kazumi YAMAMOTO, Toshiki YOSHIMINE

2001 Volume 41 Issue 6 Pages 330-332
Published: 2001
Released on J-STAGE: July 01, 2005

DOIhttps://doi.org/10.2176/nmc.41.330

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Transsphenoidal resection of pituitary tumors is usually performed with the surgeon standing on the patient's right side. However, this configuration is awkward when the tumor extends to the right and access may be hindered if the patient has poor nuchal flexibility or a large chest due to giantism or acromegaly. The surgeon stood on the left side of the patient during transsphenoidal surgery in five selected cases. The position on the left provided good access to the tumors with minimal changes in technique.

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