Neurologia medico-chirurgica

Original Articles

Retrospective Analysis of the Prevalence of Asymptomatic Cerebral Aneurysm in 4518 Patients Undergoing Magnetic Resonance Angiography

—When Does Cerebral Aneurysm Develop?—

Toru HORIKOSHI, Iwao AKIYAMA, Zentaro YAMAGATA, Hideaki NUKUI

2002 Volume 42 Issue 3 Pages 105-113
Published: 2002
Released on J-STAGE: June 19, 2005

DOIhttps://doi.org/10.2176/nmc.42.105

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The natural history of cerebral aneurysms was investigated by measuring the prevalence of incidentally found unruptured aneurysms in the general population and evaluating the characteristics including risk factors. ‘De novo’ formation of aneurysm was also demographically estimated. The prevalence of incidental aneurysm was evaluated among 4518 patients who underwent magnetic resonance (MR) angiography for various reasons in a neurosurgical institute. Double the number of patients were randomly selected from the remaining patients without aneurysm as the Control group so that sex and age group were matched to the Aneurysm group. 127 patients (2.8%) had diagnoses of aneurysm. The prevalence of asymptomatic aneurysm among middle-aged and elderly patients was predominant in women and increased with age in both sexes. Patients with aneurysms had significantly more hypertension and family history of subarachnoid hemorrhage compared to the controls. The prevalence was markedly increased in the 8th decade in men and the 7th decade in women, and new aneurysms seemed to develop predominantly around these decades. Cerebral aneurysms become detectable on MR angiography in the middle or later decades, and women tend to develop aneurysm earlier than men. Hypertension and family history of subarachnoid hemorrhage are probably risk factors for the development of aneurysm.

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Clinical Analysis of 16 Patients With Brachial Plexus Injury

Takeshi MATSUYAMA, Kazuo OKUCHI, Manabu AKAHANE, Yuji INADA, Yoshinori ...

2002 Volume 42 Issue 3 Pages 114-122
Published: 2002
Released on J-STAGE: June 19, 2005

DOIhttps://doi.org/10.2176/nmc.42.114

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Brachial plexus injury is very rare in neurosurgical practice, so many neurosurgeons have never experienced this problem in Japan. This study describes a clinical analysis of 16 patients aged 5 to 62 years (mean 32.9 years) who presented at our institution with brachial plexus injuries. Nine patients presented with paralysis and seven with paresis. Head injury was the most common associated injury in eight of 16 patients. Six patients were managed conservatively. All patients with C8-T1 paresis spontaneously recovered to a useful level. Surgery was performed in 10 patients: six neurolysis, two neurotization, and three nerve grafting procedures. All six patients who underwent neurolysis of the brachial plexus attained useful recovery. Four of five patients achieved useful recovery after nerve repair. Nerve grafting achieved a better outcome than neurotization in this study. The difference of outcome was attributed to the graft length. The management of brachial plexus injury is a great challenge, but surgical outcome can be improved if the optimal repair procedure is selected for brachial plexus injury.

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Case Reports

Blade Crossing of a Pure Titanium Clip Applied to a Cerebral Aneurysm

—Case Report—

Yutaka HIRASHIMA, Masanori KURIMOTO, Michiya KUBO, Shunro ENDO

2002 Volume 42 Issue 3 Pages 123-124
Published: 2002
Released on J-STAGE: June 19, 2005

DOIhttps://doi.org/10.2176/nmc.42.123

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Titanium aneurysm clips are superior to cobalt clips in radiological features, biocompatibility, and hypoallergenicity, but the mechanical characteristics are less advantageous. A 56-year-old man was referred to our department due to dizziness and slurred speech. Cerebral angiography unexpectedly disclosed an aneurysm of the right middle cerebral artery. The patient underwent right frontotemporal craniotomy and neck clipping of the aneurysm with a commercially pure titanium clip. After application of the clip, the clip blades crossed and nearly sheared the wall of the aneurysm. The mechanical characteristics of titanium aneurysm clips require careful consideration because of possible clip malfunction.

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Male Prolactinoma With Pituitary Apoplexy Concomitant With Intracerebral Hemorrhage

—Case Report—

Takumi ABE, Noriyoshi KAWAMURA, Hiroshi OZAWA, Motohiko SHIMAZU, Hitos ...

2002 Volume 42 Issue 3 Pages 125-127
Published: 2002
Released on J-STAGE: June 19, 2005

DOIhttps://doi.org/10.2176/nmc.42.125

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A 56-year-old male presented with a prolactin-secreting pituitary adenoma who suffered pituitary apoplexy associated with intracerebral hemorrhage of the caudate head and putamen. The centers of both the intratumoral hematoma and intracerebral hemorrhage appeared as hyperintense on T₁-weighted and T₂-weighted magnetic resonance imaging, indicating the subacute stage and probably similar timing of onset. The tumor was treated surgically 6 weeks after the onset. The causative factor for the apoplexy remains unclear.

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Giant Meningioma of the Cranial Vertex

—Case Report—

Trimurti NADKARNI, Ketan DESAI, Atul GOEL

2002 Volume 42 Issue 3 Pages 128-131
Published: 2002
Released on J-STAGE: June 19, 2005

DOIhttps://doi.org/10.2176/nmc.42.128

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A 55-year-old man was admitted with a swelling on the top of his head progressively growing for 2 years. The swelling had grown to a huge size with the appearance of a double head. A huge meningioma with predominantly extracranial growth and invasion into the superior sagittal sinus was subtotally excised. The excised tumor mass weighed 1380 g. The residual tumor was treated by irradiation. No recurrence was seen at one-year follow-up examination.

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Intracranial Germinoma With Syncytiotrophoblastic Giant Cells in the Cerebellopontine Angle

—Case Report—

Kazunori FUJIWARA, Hiroshi UENOHARA, Hiroyoshi SUZUKI, Yoshiharu SAKUR ...

2002 Volume 42 Issue 3 Pages 132-136
Published: 2002
Released on J-STAGE: June 19, 2005

DOIhttps://doi.org/10.2176/nmc.42.132

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A 23-year-old man presented with a 3-week history of left hearing disturbance and left facial nerve paresis. T₁-weighted magnetic resonance (MR) imaging showed an iso-intense mass in the left cerebellopontine angle (CPA), with homogeneous enhancement with gadolinium-diethylenetriaminepenta-acetic acid. T₂-weighted MR imaging showed the mass as heterogeneously iso- to hyperintense. Gross total removal of the tumor was achieved. Histological examination revealed that the tumor was a germinoma with syncytiotrophoblastic giant cells. Whole central nervous system irradiation with cisplatin-etoposide chemotherapy was performed postoperatively. He has been in good condition with no sign of recurrence for 7 years. Intracranial germ cell tumors in the CPA are very rare. Total surgical removal followed by irradiation and chemotherapy will provide a good outcome.

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Intradiploic Arachnoid Cyst Identified by Diffusion-Weighted Magnetic Resonance Imaging

—Case Report—

Satoshi YAMAGUCHI, Taizo HIROHATA, Masayuki SUMIDA, Kazunori ARITA, Ka ...

2002 Volume 42 Issue 3 Pages 137-139
Published: 2002
Released on J-STAGE: June 19, 2005

DOIhttps://doi.org/10.2176/nmc.42.137

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A 72-year-old woman presented with an intradiploic arachnoid cyst in the occipital intradiploic space which was found incidentally by magnetic resonance (MR) imaging. Computed tomography revealed a widened diploic space and thinning of the inner and outer tables of the occipital bone. The cyst appeared as isointense to the cerebrospinal fluid on both T₁- and T₂-weighted images. The differential diagnosis of intradiploic epidermoid cyst could be excluded because the lesion was low intensity on diffusion-weighted MR images. Arachnoid cyst is a benign lesion, so exploratory surgery should be avoided unless the cyst is symptomatic. Diffusion-weighted MR imaging is an effective modality to distinguish diploic epidermoid cysts from arachnoid cysts.

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Symptomatic Spinal Extramedullary Mass Lesion Secondary to Chronic Overdrainage of Ventricular Fluid

—Case Report—

Kenichi MATSUMOTO, Masaru OHTA, Iwao TAKESHITA

2002 Volume 42 Issue 3 Pages 140-142
Published: 2002
Released on J-STAGE: June 19, 2005

DOIhttps://doi.org/10.2176/nmc.42.140

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A 69-year-old man presented with progressive nuchal pain and spastic gait 2 years after undergoing ventriculoperitoneal (VP) shunting for a pineal astrocytoma with obstructive hydrocephalus. The neurological manifestations were compatible with radiculomyelopathy caused by an upper cervical lesion. Magnetic resonance imaging showed an enhanced extramedullary mass lesion tightly constricting the upper cervical spinal cord. The pressure of the shunt system was 150 mmH₂O, and lumbar puncture revealed normal cerebrospinal fluid (CSF) pressure of 170 mmH₂O. After removal of the shunt system, the clinical symptoms and neuroradiological findings markedly improved. This symptomatic spinal mass lesion was thought to be formed secondary to chronic depletion of ventricular CSF through the VP shunt.

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Brain Abscess Following Transorbital Penetrating Injury Due to Bamboo Fragments

—Case Report—

Jun MARUYA, Kiyoshi YAMAMOTO, Mikiko WAKAI, Uichi KANEKO

2002 Volume 42 Issue 3 Pages 143-146
Published: 2002
Released on J-STAGE: June 19, 2005

DOIhttps://doi.org/10.2176/nmc.42.143

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A 56-year-old female presented with transorbital penetrating injury caused by bamboo fragments, which resulted in brain abscess 2 weeks after the injury. Initial computed tomography (CT) of the head did not reveal the foreign bodies. However, follow-up CT demonstrated a well-defined hyperdense abnormality of 1.0 cm length in the left orbit and brain abscess in the left temporal lobe. The lesion corresponding to the hyperdense abnormality on CT appeared isointense on T₁-weighted magnetic resonance (MR) imaging and hypointense on T₂-weighted MR imaging. The bamboo fragments were surgically removed, and aspiration and continuous drainage were performed for the brain abscess. The postoperative course was uneventful and the patient was transferred to a local hospital with minor neurological deficits. Bamboo foreign bodies may show changes in properties on CT and MR imaging in the subacute stage. Careful radiological examination and follow-up monitoring are required for the correct diagnosis and treatment of such injuries.

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Flare Up of Tuberculous Abscess Following Stereotactic Aspiration

—Case Report—

Ketan DESAI, Mohinish BHATJIWALE, Trimurti NADKARNI, Atul GOEL

2002 Volume 42 Issue 3 Pages 147-149
Published: 2002
Released on J-STAGE: June 19, 2005

DOIhttps://doi.org/10.2176/nmc.42.147

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A 16-year-old non-immunocompromised and otherwise healthy patient presented with a tuberculous brain abscess. The abscess was aspirated stereotactically. Following the aspiration the disease process flared up and multiple daughter abscess cavities were discovered. The daughter abscesses were removed via craniotomy. Stereotactic aspiration requires care to prevent such flare up of the disease.

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