Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 42, Issue 8
Displaying 1-10 of 10 articles from this issue
Original Article
Case Reports
  • —Case Report—
    Hüdayi DUMAN, Ibrahim M. ZIYAL, Aydin CANPOLAT
    2002 Volume 42 Issue 8 Pages 332-333
    Published: 2002
    Released on J-STAGE: June 16, 2005
    JOURNAL OPEN ACCESS
    A 26-year-old man sustained a gunshot injury. Computed tomography (CT) demonstrated the missile in the right parietal region. Twenty-four hours later, the missile had moved towards the midline. Following slight deterioration in his neurological condition one week later, follow-up CT revealed that the missile had crossed the midline through the corpus callosum and was located in the left parietal region. CT during the second week demonstrated that the missile had stopped close to the left parietal bone. Spontaneous migration of a missile to the contralateral side via a subfalcial-transcallosal route with deterioration in neurological status is unusual. The missile may have moved under the influence of the intracranial pressure and pulsatile effect of the cerebrospinal fluid.
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  • —Case Report—
    Jae Hong SIM, Soo Chun KIM, Moo Seong KIM
    2002 Volume 42 Issue 8 Pages 334-337
    Published: 2002
    Released on J-STAGE: June 16, 2005
    JOURNAL OPEN ACCESS
    A 38-year-old non-smoker man presented with a ruptured aneurysm one month after clipping of a previous aneurysm. He was first admitted because of sudden onset of severe headache. Brain computed tomography showed subarachnoid hemorrhage. Angiography showed an aneurysm of the left anterior choroidal artery which was surgically clipped. Two weeks later, he was discharged without neurological deficits. One month after the initial hemorrhage, he was readmitted to the emergency room with stuporous mentality. Repeat angiography showed two aneurysms of the A2 portion of the left anterior cerebral artery which were not demonstrated by the initial angiography. The diagnosis was de novo aneurysms. The larger aneurysm was clipped and the other was coated. De novo aneurysm should be suspected if a patient with a previously clipped aneurysm complains of typical headache or any suggestive symptoms or signs of cranial nerve dysfunction, especially if known risk factors are present.
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  • —Case Report—
    Masanori TSUTSUMI, Kiyoshi KAZEKAWA, Akira TANAKA, Yasushi UENO, Yasuy ...
    2002 Volume 42 Issue 8 Pages 338-340
    Published: 2002
    Released on J-STAGE: June 16, 2005
    JOURNAL OPEN ACCESS
    A 62-year-old man with neurofibromatosis type 1 presented with rapid growth of a scalp mass. Head computed tomography demonstrated a large extracranial tumor of soft tissue density with massive intratumoral hematoma. Cerebral angiography demonstrated remarkable hypervascularity of the tumor. Preoperative embolization and total removal of the tumor was performed. The tumor contained a large amount of intratumoral hematoma (500 ml). The histological diagnosis was neurofibroma without malignant transformation. Benign scalp neurofibroma showing massive intratumoral hemorrhage is rare. Rapid growth or intratumoral hemorrhage in neurofibroma may be an indicator of malignant transformation.
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  • —Two Case Reports—
    Naohiro TSUYUGUCHI, Kenji OHATA, Michiharu MORINO, Toshihiro TAKAMI, T ...
    2002 Volume 42 Issue 8 Pages 341-345
    Published: 2002
    Released on J-STAGE: June 16, 2005
    JOURNAL OPEN ACCESS
    Two cases of fibrous dysplasia in the skull base bone appeared hypointense on T1- and T2-weighted magnetic resonance imaging, with accumulation of [11C]methyl-L-methionine ([11C]Met) on positron emission tomography (PET). Fibrous dysplasia is a benign bone disorder which is identified by its distinctive radiography, computed tomography, and bone scintigraphy findings. [11C]Met PET may indicate the presence of viable tumor-like cells in fibrous dysplasia.
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  • —Two Case Reports—
    Mami NAKAISO, Masaaki UNO, Masafumi HARADA, Teruyoshi KAGEJI, Osamu TA ...
    2002 Volume 42 Issue 8 Pages 346-348
    Published: 2002
    Released on J-STAGE: June 16, 2005
    JOURNAL OPEN ACCESS
    The differential diagnosis between brain abscesses and necrotic tumors such as glioblastomas is sometimes difficult to establish by conventional computed tomography and magnetic resonance imaging. Combined proton magnetic resonance spectroscopy (1H-MRS) and diffusion-weighted magnetic resonance imaging (DWI) were used to establish the preoperative diagnosis of brain abscess and glioblastoma. DWI visualized the brain abscess as a homogeneous hyperintense lesion and 1H-MRS revealed the presence of acetate, lactate, and amino acids and the absence of the normal brain components. DWI sometimes shows glioblastoma as a hyperintense lesion, but 1H-MRS reveals markedly increased lactate and decreased N-acetyl-aspartate. Combined DWI and 1H-MRS findings can distin-guish brain abscess and glioblastoma.
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  • —Case Report—
    Kenichi MATSUMOTO, Hiroyuki NAKAGAKI
    2002 Volume 42 Issue 8 Pages 349-353
    Published: 2002
    Released on J-STAGE: June 16, 2005
    JOURNAL OPEN ACCESS
    A 37-year-old female presented with a rare spinal subependymoma manifesting as progressive weakness of her right lower extremity over an 8-month period. She had a 10-year history of back pain and urinary disturbance. Magnetic resonance imaging showed diffuse enlargement of the spinal cord from T-2 to T-7 on the T1-weighted images. The enlarged spinal cord was divided into two compartments by a vertical septum-like structure on the T2-weighted images. The tumor occupied the right half of the thoracic spinal cord, and was totally removed through a laminectomy from T-2 to T-7. The histological diagnosis of the resected specimen was subependymoma. Subependymomas are slow-growing tumors usually found in the ventricular system. Spinal subependymomas are difficult to distinguish from other intramedullary spinal tumors based on neuroradiological findings. Subependymomas are surgically curable tumors, so if the tumor is well demarcated and a subependymoma is indicated, an attempt should be made to totally remove the tumor.
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  • —Case Report—
    Daisuke KITA, Shigeru MUNEMOTO, Yasunao UENO, Akiko FUKUDA
    2002 Volume 42 Issue 8 Pages 354-355
    Published: 2002
    Released on J-STAGE: June 16, 2005
    JOURNAL OPEN ACCESS
    A male neonate presented with Goldenhar's syndrome (oculoauriculovertebral dysplasia), a combination of facial microsomia and auricular malformation, associated with occipital meningoencephalocele. Three-dimensional computed tomography images clearly showed a suboccipital cranial cleft extending to the foramen magnum and hypogenesis of the left temporal bone. The patient died of heart failure due to ventricular septal defect at age 5 months.
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  • —Case Report—
    Hideyuki NAKAMA, Satoru OHTOMO, Taisuke OTSUKI, Yuu KANEKO, Takashi OH ...
    2002 Volume 42 Issue 8 Pages 356-360
    Published: 2002
    Released on J-STAGE: June 16, 2005
    JOURNAL OPEN ACCESS
    A 14-year-old boy suffered from daily epileptic seizures originating from the left polymicrogyric occipital cortex. Visual activation positron emission tomography (PET) was used to map the function of the occipital cortex presurgically. Loss of visual function in the left occipital cortex was suggested by both visual activation PET and electrical cortical stimulation. Left occipital lobectomy resulted in a completely seizure-free status without deterioration in the visual function. Preoperative evaluation of the visual function in the epileptogenic occipital cortex by activation studies using PET or functional magnetic resonance imaging is the key to the successful surgical treatment of occipital lobe epilepsy.
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  • —Case Report—
    Hiroshi TAKEDA, Mitsuo ISONO, Hidenori KOBAYASHI
    2002 Volume 42 Issue 8 Pages 361-363
    Published: 2002
    Released on J-STAGE: June 16, 2005
    JOURNAL OPEN ACCESS
    A 15-year-old girl presented with meningeal irritation and bilateral cerebral signs after contracting influenza. A lumbar puncture revealed bloody cerebrospinal fluid and polymorphonuclear predominant pleocytosis with an elevated protein level and normal glucose level. Computed tomography showed a hematoma in the right basal ganglia and lateral ventricles. Symmetrical low density areas were also noted in the bilateral white matter. The preliminary diagnosis was hemorrhagic cerebrovascular disease of unknown cause. However, her neurological condition deteriorated. Magnetic resonance (MR) imaging showed diffuse high intensity signals in the bilateral white matter and small spotty lesions, indicating hemorrhages in various stages. The final diagnosis was acute hemorrhagic leukoencephalitis (AHL). However, high-dose steroid administration and plasmapheresis failed to improve her condition. Hypothermia could not control her intracranial pressure and she died 12 days after admission. The neuroimaging findings indicated the histological characteristics of AHL, but the hematoma formation is rare. AHL is a fulminant form of brain demyelination and can be fatal, so early diagnosis and aggressive treatment are important for successful recovery. Therefore, early investigation by MR imaging is necessary.
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