Neurologia medico-chirurgica

Original Articles

Multiple Immunostaining Methods to Detect Traumatic Axonal Injury in the Rat Fluid-Percussion Brain Injury Model

Shigeru HOSHINO, Shiro KOBAYASHI, Tetsuya FURUKAWA, Takayuki ASAKURA, ...

2003 Volume 43 Issue 4 Pages 165-174
Published: 2003
Released on J-STAGE: May 28, 2005

DOIhttps://doi.org/10.2176/nmc.43.165

JOURNAL OPEN ACCESS

Show abstractHide abstract

Immunohistochemistry using beta-amyloid precursor protein (APP) N-terminus antibodies is routinely used to detect traumatic axonal injury (TAI). The temporal and regional distributions of APP C- and N-terminus immunoreactivity were investigated in rats with experimental brain injury and compared to distribution of neurofilament (NF) immunoreactivity. Male Sprague-Dawley rats underwent right lateral fluid-percussion (FP) brain injury or sham injury. Six FP injury rats and two control rats were transcardially fixed with 10% formalin at 1, 6, 24, and 48 hours, and 1 and 2 weeks after injury and serial 6 μm-thick paraffin sections were prepared. At 6 hours after injury, APP C-terminus immunostaining labeled small neurons and axonal deposits in the injured parasagittal cortex, striatum, thalami, and dorsal medulla, whereas APP N-terminus and NF immunostaining showed few axonal deposits in the parasagittal cortex. At 24-48 hours post-injury, marked axonal damage, including axonal swelling and bulbs, was observed in the injured cerebral hemisphere, cerebellar white matter, and medulla. NF immunostaining was most sensitive for axonal damage in the injured deep cortical layers, cerebellum, and medulla. At 1-2 weeks after injury, APP N-terminus immunostaining mainly showed dot-like axonal profiles in the injured thalamus. APP C-terminus immunoreactivity may serve as an early marker of TAI, and the C-terminal fragments of APP may be involved in the evolution of TAI because C-terminal fragments of APP are neurotoxic and pro-apoptotic. Multiple immunostaining methods may be required to fully recognize the extent of TAI.

View full abstract

Download PDF (710K)
In Vitro Effects of New Generation Fungal Derived Nitric Oxide Donors on Rabbit Basilar Artery

Md. Shafiqul ISLAM, Hiroki OHKUMA, Masahide KIMURA, Shigeharu SUZUKI

2003 Volume 43 Issue 4 Pages 175-180
Published: 2003
Released on J-STAGE: May 28, 2005

DOIhttps://doi.org/10.2176/nmc.43.175

JOURNAL OPEN ACCESS

Show abstractHide abstract

The fungal derived nitric oxide donors, (E)-ethyl-2-[(E)-hydroxyimino]-5-nitro-3-hexenamide (FK409) and N-[(E)-4-ethyl-3-[(Z)-hydroxyimino]-5-nitro-3-hexen-1-yl]-3-pyridinecarboxamide (FR144420), were evaluated for the treatment and prevention of cerebral vasospasm induced by subarachnoid hemorrhage (SAH) by an in vitro study using rabbit basilar artery. The tension-relaxation of a 3 mm-long artery segment was carried out in a micro-tissue organ bath with a real-time recorder to record the tension-relaxation curve. Steady contraction of the specimens was induced by KCl (n = 12) and oxyhemoglobin (oxyHb) (n = 12). Sodium nitroprusside was used for comparison. Each of the agents was added in ascending concentration. Relaxation caused by FK409 and FR144420 was significantly greater (p < 0.05) than that by sodium nitroprusside. Relaxation effects of FK409 and FR144420 on the KCl-induced steady contraction were better than those on the oxyHb-induced contraction. FK409 and FR144420 have potential uses for the treatment and prevention of SAH-induced cerebral vasospasm.

View full abstract

Download PDF (172K)
Differentiation of Pituitary Adenomas From Other Sellar and Parasellar Tumors by ^99mTc(V)-DMSA Scintigraphy

Koji YAMAMURA, Shinichi SUZUKI, Isao YAMAMOTO

2003 Volume 43 Issue 4 Pages 181-187
Published: 2003
Released on J-STAGE: May 28, 2005

DOIhttps://doi.org/10.2176/nmc.43.181

JOURNAL OPEN ACCESS

Show abstractHide abstract

Pentavalent technetium-99m dimercaptosuccinic acid [^99mTc(V)-DMSA] scintigraphy was evaluated for the differentiation of pituitary adenomas, especially non-functioning adenomas, from other sellar and parasellar lesions. Diffuse ^99mTc(V)-DMSA accumulation within the tumor was found in seven of seven non-functioning, three of four growth hormone-secreting, and seven of eight prolactin-secreting adenomas, but only partial accumulation in only two of 16 non-pituitary adenomas and normal pituitary glands. There were no significant relationship between tumor-to-background ratios and tumor size or serum hormone level. ^99mTc(V)-DMSA scintigraphy showed overall sensitivity of 81% (17/21 cases) for detecting pituitary adenomas, in particular 100% for non-functioning adenomas. ^99mTc(V)-DMSA may be useful for detecting pituitary adenomas, especially non-functioning adenomas, and for the differentiation of non-functioning pituitary adenomas from other sellar and parasellar lesions.

View full abstract

Download PDF (270K)

Case Reports

Acute Surgery for Ruptured Dissecting Aneurysm of the M₃ Portion of the Middle Cerebral Artery

—Case Report—

Shigeyuki SAKAMOTO, Fusao IKAWA, Hitoshi KAWAMOTO, Naohiko OHBAYASHI, ...

2003 Volume 43 Issue 4 Pages 188-191
Published: 2003
Released on J-STAGE: May 28, 2005

DOIhttps://doi.org/10.2176/nmc.43.188

JOURNAL OPEN ACCESS

Show abstractHide abstract

A 65-year-old woman presented with a ruptured dissecting aneurysm of the M₃ portion of the middle cerebral artery (MCA) manifesting as disturbance of consciousness and motor aphasia. Computed tomography revealed subarachnoid hemorrhage. Emergent angiography demonstrated segmental aneurysmal dilatation of the M₃ portion of the left MCA. Infectious aneurysm was excluded. Surgery was performed to prevent repeated hemorrhage from the aneurysm. The lesion was excised and flow to the distal MCA was preserved with an anastomosis of the superficial temporal artery to the MCA. Histological examination confirmed that the aneurysmal dilatation was due to arterial dissection caused by disruption of the internal elastic lamina. Distal dissecting aneurysm may occur in the absence of infectious disease. Such ruptured distal dissecting aneurysm should preferably be treated surgically in the acute stage, immediately after detection of the aneurysm. The parent artery of the proximal and distal sides of the aneurysm should be trapped because of the probable weakness of the arterial wall, and bypass surgery performed to preserve the distal circulation.

View full abstract

Download PDF (229K)
Repeated Thrombus Formation Immediately Following Carotid Endarterectomy

—Case Report—

Tetsuyuki YOSHIMOTO, Takeshi AOYAMA, Tomohide SHIRASAKA, Takeshi YOSHI ...

2003 Volume 43 Issue 4 Pages 192-196
Published: 2003
Released on J-STAGE: May 28, 2005

DOIhttps://doi.org/10.2176/nmc.43.192

JOURNAL OPEN ACCESS

Show abstractHide abstract

A 56-year-old male presented with thrombus formation manifesting as cerebral embolic infarction suspected to be caused by hemostasis at the carotid bifurcation, not by the intimal abnormalities or hematological disorders. Thrombus repeatedly and reproducibly appeared at the same area in spite of carotid endarterectomy (CEA). Ultrasonography demonstrated a stenotic lesion of the cervical carotid bifurcation. Medical treatment reduced the stenosis, but the thrombus was repeatedly formed at the same area of the cervical carotid bifurcation. CEA was performed. Histological examination of the specimen found only the underlying thin intima consisting of mild fibrous atheromatic change without ulceration or vascular dissection. Ultrasonography following CEA showed reduced blood flow, indicating hemostasis, and moyamoya appearance in that area. The thrombus had recurred in spite of the medical treatment with anti-platelet agent. This repeated thrombus was gradually dissolved and reduced with anticoagulant therapy. Thrombus causing cerebral embolic stroke and originating at the cervical carotid bifurcation is usually due to the intimal atherosclerotic change such as ulcer formation or vascular dissection. The thrombus in this case was probably formed by hemostasis at the cervical carotid bifurcation and CEA was not effective to prevent recurrence.

View full abstract

Download PDF (379K)
Acute Subdural Hematoma After Lumboperitoneal Shunt Placement in Patients With Normal Pressure Hydrocephalus

—Four Case Reports—

Takanori KAMIRYO, Jun-ichiro HAMADA, Isao FUWA, Yukitaka USHIO

2003 Volume 43 Issue 4 Pages 197-200
Published: 2003
Released on J-STAGE: May 28, 2005

DOIhttps://doi.org/10.2176/nmc.43.197

JOURNAL OPEN ACCESS

Show abstractHide abstract

Acute subdural hematoma (SDH) is a rare but disastrous complication after lumboperitoneal shunt placement. Four of 206 adult patients with normal pressure hydrocephalus (1.9%) who underwent lumboperitoneal shunt placement suffered acute SDH following head trauma. The interval between shunt placement and acute SDH was one month to 7 years. Two patients had subdural effusion on computed tomography (CT) at 2- and 6-month follow up. All four patients required assistance in their daily activities before acute SDH onset. The traumatic event was a fall. On admission, CT revealed a large SDH that required surgical removal in two patients, of whom one had manifested subdural effusion after shunt placement. The other two patients had a small SDH. None of the four patients had cerebral contusions. Patients with lumboperitoneal shunts, especially those not capable of independent daily activities, are at risk for acute SDH after even minor head trauma.

View full abstract

Download PDF (265K)
Reversible Bilateral Vestibular Impairment Caused by Fourth Ventricle Epidermoid Tumor

—Case Report—

Atsushi KAMBE, Yuichi ANNO, Naoharu ODA, Yousaku SHIOMI, Hidenobu AOKI ...

2003 Volume 43 Issue 4 Pages 201-203
Published: 2003
Released on J-STAGE: May 28, 2005

DOIhttps://doi.org/10.2176/nmc.43.201

JOURNAL OPEN ACCESS

Show abstractHide abstract

A 26-year-old man presented with an epidermoid tumor of the fourth ventricle manifesting as headache with nausea and vertigo. Neurological examination revealed no cerebellar signs, except nystagmus. Bilateral vestibular impairment was identified by the caloric test. The tumor was removed via the midline suboccipital approach. The bilateral peripheral vestibular function recovered remarkably postoperatively. This marked improvement suggests that the bilateral vestibular impairment was caused by compression of the vestibular nuclei by the tumor.

View full abstract

Download PDF (155K)
Surgical Strategy for Anterior Sacral Meningocele

—Two Case Reports—

Satoshi TANI, Yoshiji OKUDA, Toshiaki ABE

2003 Volume 43 Issue 4 Pages 204-209
Published: 2003
Released on J-STAGE: May 28, 2005

DOIhttps://doi.org/10.2176/nmc.43.204

JOURNAL OPEN ACCESS

Show abstractHide abstract

A 25-year-old male presented with an anterior sacral meningocele (ASM) manifesting as repeated urinary tract infections. Surgical correction was completed by simple ligation of the thecal sac next to the ostium via sacral laminectomy, and the thickened filum terminale was sectioned. A 22-year-old female presented with an ASM manifesting as transient difficulty in micturition. Subsequent to sacral laminectomy, the thickened filum terminale was sectioned. However, an aberrant nerve root over the ostium made simple ligation hazardous, so that transdural suture around the ostium was carried out. Complete obliteration was confirmed 5 months after the surgery. Magnetic resonance (MR) imaging could clearly demonstrate the involvement of neurologically important structures. Surgical strategy for ASM based on neurosurgical considerations is proposed, because of the frequent association of caudal spinal cord anomaly as well as presacral mass lesion. Intraoperative assistance systems such as endoscopy for cyst content examination and neurophysiological monitorings are recommended. Several months follow up with MR imaging is required to confirm successful surgical correction.

View full abstract

Download PDF (267K)
Brucellar Spondylodiscitis in the Lumbar Region

—Case Report—

Mehmet TURGUT, Ömer Faruk SENDUR, Mustafa GÜREL

2003 Volume 43 Issue 4 Pages 210-212
Published: 2003
Released on J-STAGE: May 28, 2005

DOIhttps://doi.org/10.2176/nmc.43.210

JOURNAL OPEN ACCESS

Show abstractHide abstract

A 59-year-old male farmer presented with a rare case of spondylodiscitis as a manifestation of systemic brucellosis. The patient presented with radicular pain and restricted mobility of the spine due to localized muscle spasm in addition to systemic complaints. Magnetic resonance imaging demonstrated discovertebral involvement at the L4-5 intervertebral space, indicating infectious spondylodiscitis. The Rose-Bengal test was positive and the serum antibody titer was 1/1280. The patient was treated with streptomycin combined with tetracycline plus rifampicin, with complete recovery. Early diagnosis is important and prompt antibrucellar chemotherapy is effective in most cases. Therefore, spondylodiscitis due to brucellosis should be considered in the differential diagnosis of spinal infections.

View full abstract

Download PDF (145K)
Late Bilateral Temporal Lobe Necrosis After Conventional Radiotherapy

—Case Report—

Michio HOSHI, Toshiyuki HAYASHI, Hiroshi KAGAMI, Ikurou MURASE, Masash ...

2003 Volume 43 Issue 4 Pages 213-216
Published: 2003
Released on J-STAGE: May 28, 2005

DOIhttps://doi.org/10.2176/nmc.43.213

JOURNAL OPEN ACCESS

Show abstractHide abstract

A 63-year-old woman presented with radionecrosis in the bilateral temporal lobes manifesting as dementia about 30 years after undergoing conventional radiotherapy for pituitary adenoma. Computed tomography and magnetic resonance (MR) imaging showed edema and cystic lesions in both temporal lobes. The mass in the left temporal lobe was excised. MR imaging 12 days after surgery showed reduced edema. Her dementia had improved. Radionecrosis usually occurs between several months and a few years after radiotherapy. The incidence of radionecrosis is estimated as 5%, but may be higher with longer follow-up periods. Clinical reports have suggested that larger total doses of radiation are associated with earlier onset of delayed necrosis and the fractional dose is the most significant factor causing cerebral radionecrosis. Radionecrosis can occur long after conventional radiotherapy or stereotactic radiosurgery using a linac-based system or a gamma knife unit.

View full abstract

Download PDF (288K)

Register with J-STAGE for free!