Neurologia medico-chirurgica

Original Article

Etizolam, an Anti-anxiety Agent, Attenuates Recurrence of Chronic Subdural Hematoma

—Evaluation by Computed Tomography—

Yutaka HIRASHIMA, Naoya KUWAYAMA, Hideo HAMADA, Nakamasa HAYASHI, Shun ...

2002 Volume 42 Issue 2 Pages 53-56
Published: 2002
Released on J-STAGE: June 20, 2005

DOIhttps://doi.org/10.2176/nmc.42.53

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Etizolam, an anti-anxiety agent which is an antagonist of platelet-activating factor receptors, was administered to patients with chronic subdural hematoma (CSH) after hematoma removal to assess the effectiveness for preventing recurrence compared with control patients not given the drug after surgery. The remaining volumes of subdural hematomas on brain computed tomography were measured approximately 1 month after removal. Volume in the etizolam group (15 patients) was significantly smaller than in the control group (24 patients). Hematoma recurrence was not detected in the etizolam group 3 months after surgery, but occurred in the control group. The difference was significant. Etizolam administration may be useful for the prevention of recurrence of CSH.

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Case Reports

Bypass Surgery for Occluded Internal Carotid Artery Revascularized by Vasa Vasorum

—Case Report—

Hiroaki SHIMIZU, Teiji TOMINAGA, Masayuki EZURA, Takashi YOSHIMOTO

2002 Volume 42 Issue 2 Pages 57-61
Published: 2002
Released on J-STAGE: June 20, 2005

DOIhttps://doi.org/10.2176/nmc.42.57

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A 47-year-old woman presented with two transient ischemic attacks due to occlusion of the left internal carotid artery. The affected artery was revascularized by vasa vasorum. Angiography showed occlusion of the left common carotid artery including the origin of the internal carotid artery. The distal internal carotid artery was revascularized by vasa vasorum at the level of the second cervical vertebral body. Left subclavian artery-internal carotid artery bypass surgery using a saphenous vein graft was performed successfully, during which the narrowed but patent lumen of the internal carotid artery was confirmed. Follow-up angiography showed enlargement of the left internal carotid artery distal to the patent bypass. Reconstructive bypass surgery is a possible treatment for patients with occluded internal carotid artery revascularized by vasa vasorum. Angiographic detection of the lumen of the internal carotid artery is important for surgical consideration.

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Dissecting Aneurysm of the Middle Cerebral Artery Manifesting as Subarachnoid Hemorrhage and Hemorrhagic Infarctions

—Case Report—

Shuji NIIKAWA, Jun YAMADA, Yasuhiko SUMI, Haruki YAMAKAWA

2002 Volume 42 Issue 2 Pages 62-66
Published: 2002
Released on J-STAGE: June 20, 2005

DOIhttps://doi.org/10.2176/nmc.42.62

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A 46-year-old woman presented with a dissecting aneurysm of the right middle cerebral artery manifesting as subarachnoid hemorrhage followed by hemorrhagic infarctions. The aneurysm was clipped and wrapped. However, serial angiography showed progression of the lesion, which was probably responsible for the clinical course of this patient. Intracranial dissecting aneurysms are less common, and the natural history of these lesions is unclear. Conservative management might be preferable in this patient.

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Congenital Multiple Cavernous Angiomas Associated With Thrombosed Arteriovenous Malformation of the Brain

—Case Report—

Yasuhiko HAYASHI, Yasuo TOHMA, Masanao MOURI, Tetsumori YAMASHIMA, Jun ...

2002 Volume 42 Issue 2 Pages 67-72
Published: 2002
Released on J-STAGE: June 20, 2005

DOIhttps://doi.org/10.2176/nmc.42.67

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A 16-year-old girl presented with multiple cerebral cavernous angiomas with calcifications due to repeated hemorrhages and a thrombosed cerebral arteriovenous malformation (AVM). Her 18-year-old elder sister also had multiple cerebral cavernous angiomas associated with calcifications, which suggested presence of repeated previous hemorrhages. Surgical removal via a right occipital craniotomy resulted in a good outcome. The histological diagnosis was thrombosed AVM. Evaluation of congenital vascular anomaly needs to take into consideration the combination of other congenital vascular anomalies and their familial occurrence.

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Primary Rhabdomyosarcoma Associated With Tumoral Hemorrhage

—Case Report—

Takashi MITSUHASHI, Kentaro MORI, Ryo WADA, Minoru MAEDA

2002 Volume 42 Issue 2 Pages 73-77
Published: 2002
Released on J-STAGE: June 20, 2005

DOIhttps://doi.org/10.2176/nmc.42.73

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A 42-year-old female presented with right hemiparesis. Computed tomography (CT) demonstrated a slightly heterogeneous high density mass over the left frontal convexity with peritumoral edema, with homogeneous enhancement by contrast material. Magnetic resonance imaging showed the left frontal convexity tumor as a heterogeneous low intensity area on the T₁-weighted image and a heterogeneous high intensity area on the T₂-weighted image, with homogeneous enhancement and dural tail sign after intravenous administration of gadolinium-diethylenetriaminepenta-acetic acid. After admission, the patient suddenly lost consciousness. CT demonstrated aggressive increase in the bulk of the tumor and large peritumoral hemorrhage. The tumor was totally removed. The histological diagnosis was rhabdomyosarcoma. Combined immunohistochemistry and electron microscopy techniques should be used to differentiate rhabdomyosarcoma from malignant meningioma.

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Lumbosacral Metastatic Extradural Merkel Cell Carcinoma Causing Nerve Root Compression

—Case Report—

Mehmet TURGUT, Deniz GÖKPINAR, Sabri BARUTÇA, Muhan ERKUS

2002 Volume 42 Issue 2 Pages 78-80
Published: 2002
Released on J-STAGE: June 20, 2005

DOIhttps://doi.org/10.2176/nmc.42.78

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A 63-year-old man presented with a rare metastatic Merkel cell carcinoma (MCC) involving the lumbosacral spine and causing nerve root compression. Magnetic resonance (MR) imaging revealed an extradural soft tissue mass at the L5-S1 levels. The tumor was subtotally removed and chemotherapy was administered, but he died of multiple metastases from the primary epigastric tumor. Lumbosacral metastatic epidural tumor can manifest as lumbar disc disease symptoms, but MR imaging can non-invasively and rapidly reveal the presence of spinal epidural tumor and any extension to the spinal canal. Extradural MCC metastasis in the lumbosacral area should be considered in the differential diagnosis of radicular symptoms caused by disc herniation.

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Neuroendoscopic Treatment of Idiopathic Occlusion of the Foramen of Monro in Adults

—Two Case Reports—

Dirk FREUDENSTEIN, Frank DUFFNER, Hilmar KRAPF, Alexandra WAGNER, Erns ...

2002 Volume 42 Issue 2 Pages 81-85
Published: 2002
Released on J-STAGE: June 20, 2005

DOIhttps://doi.org/10.2176/nmc.42.81

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Two adults presented with hydrocephalus due to idiopathic obstruction of the bilateral foramina of Monro, manifesting as clinical signs of chronically elevated intracranial pressure. No inflammation was present. The primary surgical treatment was neuroendoscopic reconstruction of the right foramen of Monro. A 37-year-old man had a spontaneous perforation of the septum pellucidum. The patient required a ventriculoperitoneal shunt, although postoperative ventriculography proved free passage of cerebrospinal fluid from the lateral ventricle into the third ventricle. A 62-year-old man underwent additional septostomy and third ventriculostomy, and the neuroendoscopic intervention relieved the presenting symptoms without additional treatment. The biopsy specimens showed no evidence of malignancy in either case. Neuroendoscopic intervention is an alternative treatment in the management of hydrocephalus due to idiopathic obstruction of the foramen of Monro. The procedure is less invasive than open microsurgical reconstruction and can even avoid ventriculoperitoneal or ventriculoatrial shunting.

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Detection and Characterization of the Evolution of Cerebral Abscesses with Diffusion-Weighted Magnetic Resonance Imaging

—Two Case Reports—

Takeshi MIKAMI, Koji SAITO, Takaaki KATO, Shinsuke IRIE, Junpei YOSHIK ...

2002 Volume 42 Issue 2 Pages 86-90
Published: 2002
Released on J-STAGE: June 20, 2005

DOIhttps://doi.org/10.2176/nmc.42.86

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A 57-year-old man and a 45-year-old woman presented with cerebral abscesses. Diffusion-weighted magnetic resonance (MR) imaging and conventional MR imaging clearly showed the different stages of the course of the brain abscesses. As the abscess matured, the signal intensity of the center gradually increased to the typical high value with a low apparent diffusion coefficient (ADC) on diffusion-weighted MR imaging, and enhancement of the capsule on T₁-weighted MR imaging with gadolinium. Healing of the abscess was revealed by the signal intensity of the center returning to isointense and an increase in ADC to the baseline. Surrounding edema showed an increase in ADC, followed by a return to the baseline. These changes probably reflect the pathological processes occurring in the abscesses.

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Technical Notes

Presigmoid Approach for Cavernous Angioma in the Pons

—Technical Note—

Yoshitsugu OIWA, Kunio NAKAI, Yasutomo MASAKI, Osamu MASUO, Toshikazu ...

2002 Volume 42 Issue 2 Pages 91-98
Published: 2002
Released on J-STAGE: June 20, 2005

DOIhttps://doi.org/10.2176/nmc.42.91

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Surgical treatment of brainstem lesions has been encouraged after the development of magnetic resonance imaging. However, direct approaches to intra-axial lesions in the brainstem still carry a high risk of morbidity because the neuronal structures can be injured along the entry routes. We present two patients whose pontine cavernous angiomas were removed via incision of the lateral aspect of the pons with presigmoid approach. The first case, a 41-year-old woman, presented with paresis of the cranial nerves VI, VII, and VIII, and left hemiparesis progressing over 2 weeks caused by a cavernous angioma ventrally located in the lower pons. The second case, a 50-year-old woman, developed dizziness over 2 months due to a large cavernous angioma in the center of the pons. These lesions were totally removed through the presigmoid approach and no additional neurological deficits were observed. An image-guided navigation system was used for the craniotomy and removal of the lesion in the second patient. The presigmoid approach provides a safe route to intra-axial lesions in the pons. A technique for presigmoid craniotomy with one-piece bone flap under the image-guided navigation is also described.

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Endoscopic Ventriculocystostomy Through the Septum Pellucidum Via the Contralateral Anterior Horn

—Technical Note—

Nakamasa HAYASHI, Hideo HAMADA, Kimiko UMEMURA, Masanori KURIMOTO, Yut ...

2002 Volume 42 Issue 2 Pages 99-102
Published: 2002
Released on J-STAGE: June 20, 2005

DOIhttps://doi.org/10.2176/nmc.42.99

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Paraventricular fluid cysts have recently been treated by endoscopic fenestration performed from the cysts to the ventricular system. However, correct orientation and safe navigation of the endoscope may be difficult in patients with abnormal anatomy. Endoscopic fenestration from the ventricular system to a cyst was performed through penetration of the septum pellucidum via the anterior horn of the contralateral lateral ventricle. The advantage of this approach is correct orientation and introduction of the endoscope to the periventricular lesion because the usual landmarks can be identified in the normal contralateral lateral ventricle.

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