Neurologia medico-chirurgica

Original Articles

Endogenous Nitric Oxide Synthesis Differentially Modulates Pressure-Flow and Pressure-Conductance Relationships in the Internal and External Carotid Artery Circulations of the Rat

Hiroshi UJIIE, David H. EDWARDS, Tudor M. GRIFFITH

2002 Volume 42 Issue 12 Pages 527-535
Published: 2002
Released on J-STAGE: June 11, 2005

DOIhttps://doi.org/10.2176/nmc.42.527

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The role of endogenous nitric oxide (NO) synthesis was investigated in the regulation of the internal (ICA) and external carotid artery (ECA) beds of ventilated, anesthetized rats in a model in which the left common carotid artery was perfused from the aorta via an extracorporeal circuit under conditions of non-pulsatile controlled flow. The territories supplied by the extracranial ICA and ECA were studied separately following occlusion of the appropriate artery. An inhibitor of nitric oxide synthesis, N^G-monomethyl-L-arginine (L-NMMA), and the NO synthase substrate L-arginine were administered via a jugular venous catheter. NO synthesis exerted an important influence on the pressure-flow relationships of the ICA and ECA circulations as L-NMMA increased input perfusion pressure at any given flow rate. However, in the presence of NO synthesis, hydraulic conductance increased rapidly with flow in the ICA, thereby stabilizing perfusion pressures over a wide range of flow rates, whereas this phenomenon was not evident in the ECA territory. Differences between the two circulations were further emphasized by observations that L-arginine antagonized the systemic hemodynamic response to L-NMMA and its effects on the conductance of the ECA bed, whereas the effects of L-NMMA were irreversible in the ICA territory.

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Gross Total Removal of Gliomas in the Pulvinar and Correlative Microsurgical Anatomy

Ryoji ISHII, Yasuo SUZUKI, Akira WATANABE, Yutaka MOURI, Norihiro ISHI ...

2002 Volume 42 Issue 12 Pages 536-546
Published: 2002
Released on J-STAGE: June 11, 2005

DOIhttps://doi.org/10.2176/nmc.42.536

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Tumors in the pulvinar tend to present as circumscribed lesions with exophytic growth into the lateral and third ventricles. These lesions may be best explored via a parietal-transcortical-transventricular approach. If the tumor extends posteriorly or inferiorly, a posterior-interhemispheric-transtentorial approach may provide a good angle of access. Gross total removal of the tumors in the pulvinar of two patients was achieved by surgical sectioning of the unilateral crus of the fornix or the splenium via a transventricular or interhemispheric approach with acceptable risk. These patients are now doing well as students about 6 years following the first operations. During tumor removal, a posterior-interhemispheric-transtentorial approach combined with above-mentioned approaches was useful for orientation of the critical structures in the posterior incisural space. Knowledge of the anatomical relationships of the pulvinar to the crus of the fornix and the choroid plexus, and to the critical structures located in the posterior incisural space is extremely important for neurosurgeons.

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Case Reports

Bilateral Cephalhematomas in a Juvenile

—Case Report—

Kazunori FUJIWARA, Keiichi SAITO, Tsutomu EBINA

2002 Volume 42 Issue 12 Pages 547-549
Published: 2002
Released on J-STAGE: June 11, 2005

DOIhttps://doi.org/10.2176/nmc.42.547

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A 14-year-old boy presented with subperiosteal cephalhematomas in bilateral parietotemporal sites after a minor head injury. Magnetic resonance (MR) imaging showed that one of the hematomas had progressed beyond suture lines, and spread under the temporal muscle layer. Progressive enlargement of the cephalhematomas occurred despite medical and needle aspiration treatment. Surgery found that the hematoma had separated the periosteum from the skull bone surface, and the periosteum had lost the tight attachment to the suture lines. Continuous suction-drainage reduced the size of the hematomas without complications. MR imaging can identify subperiosteal cephalhematomas. The relationship of the hematoma and the temporal muscle may be the key MR imaging finding for the diagnosis of cephalhematoma. We suggest that some juvenile cephalhematomas may be a different clinical entity from those occurring in neonates.

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Cervical Epidural Hematoma After Snowboarding Injury

—Case Report—

Takeshi KONDOH, Eiji KURIHARA, Eiji KOHMURA

2002 Volume 42 Issue 12 Pages 550-553
Published: 2002
Released on J-STAGE: June 11, 2005

DOIhttps://doi.org/10.2176/nmc.42.550

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A 21-year-old man developed cervical spinal epidural hematoma one month after a snowboarding injury. He fell down while snowboarding and hit his occiput. Immediately after the injury, he suffered hypesthesic pain in the C-8 area associated with dull neck pain, which persisted for a month. Radiography of the cervical spine detected no pathological findings. The second attack of pain occurred when he was resting, followed by paraparesis and loss of urinary sensation within 24 hours. Emergent magnetic resonance (MR) imaging demonstrated an epidural hematoma at the levels of C-7 to T-2 which compressed the spinal cord. During the operation for removal of the hematoma, arterial rebleeding occurred from a small artery in the dural sac on the right C-8 root, which was thought to be responsible for the hematoma. The patient was discharged with no neurological deficits. Snowboarding-related injuries occur with higher frequency and involve greater risks compared to skiing-related injuries. Repeat MR imaging is strongly recommended to follow up any spinal injury, particularly in cases associated with focal neurological signs.

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Subdural Hygroma as a Complication of Endoscopic Neurosurgery

—Two Case Reports—

Dirk FREUDENSTEIN, Alexandra WAGNER, Ulrike ERNEMANN, Frank DUFFNER

2002 Volume 42 Issue 12 Pages 554-559
Published: 2002
Released on J-STAGE: June 11, 2005

DOIhttps://doi.org/10.2176/nmc.42.554

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Two cases of subdural hygroma occurred in a series of 77 neuroendoscopic procedures. An 8-year-old boy underwent neuroendoscopic cysto-cisternostomy of a left temporal arachnoid cyst. Routine postoperative magnetic resonance imaging 7 days later showed a large left-sided subdural hygroma without clinical symptoms. During the following 3 months, the subdural hygroma did not resolve spontaneously, so it was drained through a burr hole. A 3-month-old boy with aqueductal stenosis developed bilateral subdural hygromas after third ventriculostomy. Several punctures through the open anterior fontanelle relieved the hygromas but increasing head circumference required ventriculoperitoneal shunting 12 months later. Complications of neuroendoscopic procedures are increasingly reported, including various kinds of bleeding, infections, or damage of neuronal tissue. Only three previous cases of subdural hygroma or hematoma after neuroendoscopic interventions have been reported. The possible etiologies and clinical consequences of this rare complication have to be considered before selecting neuroendoscopy treatment.

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Dissecting Basilar Artery Aneurysm Growing During Long-term Follow Up

—Case Report—

Shinya NABIKA, Shuichi OKI, Keisuke MIGITA, Naoyuki ISOBE, Takahito OK ...

2002 Volume 42 Issue 12 Pages 560-564
Published: 2002
Released on J-STAGE: June 11, 2005

DOIhttps://doi.org/10.2176/nmc.42.560

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A 58-year-old male presented with a dissecting aneurysm of the basilar artery manifesting as dysarthria, left hemiparesis, and numbness of the left side. Angiography revealed a double lumen at the midportion of the basilar artery which was consistent with a diagnosis of dissecting basilar artery aneurysm. The patient was treated conservatively, and remained neurologically stable for a 5-year period following initial presentation, but serial magnetic resonance imaging revealed growth of the aneurysm compressing the brain stem. His condition then worsened. Computed tomography revealed obstructive hydrocephalus. Ventriculoperitoneal shunting was performed and the patient's symptoms improved. However, he died of subarachnoid hemorrhage. Autopsy showed the patient had had a type 3 “dolichoectatic dissecting aneurysm.” Surgical treatment should be seriously considered for treating the patients with dissecting basilar artery aneurysm causing brain stem ischemia, especially if the aneurysm is growing. High-flow bypass and proximal occlusion may be the choice in patients with poor collateral circulations.

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Facial Nerve Palsy After Intracisternal Papaverine Application During Aneurysm Surgery

—Case Report—

Erhard W. LANG, Mark NEUGEBAUER, Karl NG, Victor FUNG, Paul CLOUSTON, ...

2002 Volume 42 Issue 12 Pages 565-567
Published: 2002
Released on J-STAGE: June 11, 2005

DOIhttps://doi.org/10.2176/nmc.42.565

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A 61-year-old woman suffered transient mydriasis and prolonged facial nerve palsy after intracisternal papaverine application subsequent to elective clipping of an unruptured middle cerebral artery aneurysm. The mydriasis resolved within 90 minutes, but the facial nerve dysfunction persisted for 2 months before complete recovery. Prolonged irrigation of the cisterns may have washed the papaverine into contact with the facial nerve. This case supports previously reported evidence of a possible effect of topical intracisternal papaverine hydrochloride application on the facial nerve.

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Giant Cell Glioblastoma Manifesting as Traumatic Intracerebral Hemorrhage

—Case Report—

S. Meltem CAN, Yunus AYDIN, Osman TURKMENOGLU, Faruk AYDIN, Ibrahim ZI ...

2002 Volume 42 Issue 12 Pages 568-571
Published: 2002
Released on J-STAGE: June 11, 2005

DOIhttps://doi.org/10.2176/nmc.42.568

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A 33-year-old male presented with intracerebral hemorrhage in the left temporoparietal region after a traffic accident. Ten months later, the traumatic hemorrhage was found to originate in an underlying giant cell glioblastoma. Our case indicates that non-traumatic underlying pathologies, such as vasculopathies, coagulopathies, or tumors, should be considered in the differential diagnoses of intracerebral hemorrhage occurring in unusual locations after traumatic accidents.

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Peritoneal Shunt Migration into the Pulmonary Artery

—Case Report—

Shigeki KUBO, Hiroshi TAKIMOTO, Shuji TAKAKURA, Kousuke IWAISAKO, Kazu ...

2002 Volume 42 Issue 12 Pages 572-574
Published: 2002
Released on J-STAGE: June 11, 2005

DOIhttps://doi.org/10.2176/nmc.42.572

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A 48-year-old man underwent ventriculoperitoneal shunting for hydrocephalus secondary to subarachnoid hemorrhage due to left vertebral artery dissection, which had been successfully treated by trapping. The peritoneal catheter was correctly positioned via a right upper abdominal incision, and symptoms related to the hydrocephalus disappeared. One month later, the patient began to complain of pain on the right side of the neck. Chest radiography revealed that the peritoneal end of the catheter had migrated into the right pulmonary artery. The catheter route was explored through a small neck incision, and was found to enter the external jugular vein. The catheter was extracted and repositioned into the peritoneum. This type of shunt migration is quite unusual, but could be lethal by causing pulmonary infarction or arrhythmia. The catheter had probably entered the external jugular vein through a perforation caused by the shunt guide during the ventriculoperitoneal shunt operation. Follow-up radiography should be scheduled to detect such a complication.

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Thoracic Intramedullary Cysticercosis

—Two Case Reports—

Dattatraya MUZUMDAR, Trimurti NADKARNI, Ketan DESAI, Kaustubh DINDORKA ...

2002 Volume 42 Issue 12 Pages 575-579
Published: 2002
Released on J-STAGE: June 11, 2005

DOIhttps://doi.org/10.2176/nmc.42.575

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A 36-year-old male and a 20-year-old male presented with intramedullary cysticercosis in the thoracic spinal cord. Magnetic resonance imaging clearly identified the cysts. Surgery was performed to decompress the spinal cord, as both patients had progressive and severe worsening of their neurological condition. Intramedullary cysticercosis can be treated successfully by surgery and/or medical therapy.

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