Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 44, Issue 2
Displaying 1-12 of 12 articles from this issue
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Original Articles
  • Tissue Plasminogen Activator Levels After Single Intracisternal Injection in Patients With Subarachnoid Hemorrhage
    Junya JITO, Yoko NAKASU, Satoshi NAKASU, Naoki HATSUDA, Masayuki MATSU ...
    2004 Volume 44 Issue 2 Pages 55-60
    Published: 2004
    Released on J-STAGE: March 07, 2005
    DOIhttps://doi.org/10.2176/nmc.44.55
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    Tissue plasminogen activator (tPA) levels were investigated in the cisternal fluid of patients with subarachnoid hemorrhage treated with single intracisternal injection of recombinant tPA during radical surgery for ruptured aneurysms. Seven patients received different doses of tPA: two of 400 μg/ml, three of 500 μg/ml, one of 700 μg/ml, and one of 800 μg/ml in a total amount of 20 ml distilled water at pH 7. Cerebrospinal fluid samples were taken directly from the cisternal fluid at 15-minute incubation after injection, immediately after irrigation during surgery, and by lumbar tap 2 days after surgery. Cisternal tPA levels decreased to about 60% of the mean injected doses after 15-minute incubation. Simple linear regression analysis showed these tPA levels after incubation correlated with the initial doses. After copious irrigation with Ringer solution at pH 8, tPA levels decreased rapidly without correlation with the initial doses. After spinal drainage for 2 days, tPA levels further decreased by an order of 10-4 to 10-6 from the initial dose. These values were still greater than normal controls. The final values of tPA levels were not related to the initial dose. None of the patients suffered from systemic or wound complications. Cisternal tPA injection with increased doses and irrigation may be beneficial for the selective rapid removal of blood clots with controllable safety.
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  • Interlaminar Fixation Using the Atlantoaxial Posterior Fixation System (3XS System) for Atlantoaxial Instability: Surgical Results and Biomechanical Evaluation
    Shigeru NISHIZAWA, Mitsuo YAMAGUCHI, Yuji MATSUZAWA
    2004 Volume 44 Issue 2 Pages 61-67
    Published: 2004
    Released on J-STAGE: March 07, 2005
    DOIhttps://doi.org/10.2176/nmc.44.61
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    This study evaluated the surgical results for patients with atlantoaxial instability due to various lesions treated using the atlantoaxial posterior fixation system (3XS system; Kisco DIR, Paris, France), together with a biomechanical study of this system. The strength of the 3XS system during torsion was examined using a biomechanical simulation model. The 3XS system consists of a transverse unit, hooks, and rods. The lower part of the biomechanical simulation machine was rigidly fixed and the upper part was movable, allowing torsion to be applied until the point of failure. The test was started at 1.5 newton-meters, thought to be the maximum load on the upper cervical spine. The 3XS system tolerated torsion of up to 20 newton-meters, but became deformed. The instrument was fractured at 30 newton-meters. Fifteen patients, four with atlantoaxial instability, seven with os odontoideum, and four with odontoid fractures, underwent surgery using the 3XS system and an iliac bone fragment inserted between the C-1 and C-2 laminae. Postoperative rigid fixation of the lesion and optimal cervical alignment was obtained in all patients, and the patients were discharged within 2 weeks after surgery. Follow-up radiography showed bony fusion between C-1 and C-2 in all patients. Posterior fixations between C-1 and C-2 using the 3XS system were easy to perform and no surgical complications were encountered. The biomechanical study showed the 3XS system can tolerate torsions unlikely to occur during rotation movements in the atlantoaxial region in humans. The surgical use of the 3XS system for the treatment of atlantoaxial instability has several advantages.
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Case Reports
  • Arteriovenous Malformation Surrounding the Trigeminal Nerve
    —Case Report—
    Boris KRISCHEK, Sachiko YAMAGUCHI, Ulrich SURE, Ludwig BENES, Siegfrie ...
    2004 Volume 44 Issue 2 Pages 68-71
    Published: 2004
    Released on J-STAGE: March 07, 2005
    DOIhttps://doi.org/10.2176/nmc.44.68
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    A 57-year-old man presented with subarachnoid hemorrhage due to the rupture of an arteriovenous malformation (AVM) located at the base of the root of the right trigeminal nerve. In contrast to previous similar cases, his history included no evidence of trigeminal neuralgia or sensory loss. Right vertebral artery angiography revealed a doubled superior cerebellar artery feeding the angioma nidus. The patient refused radiotherapy and preferred surgical treatment. Intraoperatively, a close relationship between arterial feeders and rootlets of the trigeminal nerve was observed. Complete removal of the malformation was achieved and confirmed angiographically. The postoperative course was complicated by subdural hygroma that required repeated drainage and eventually a shunting procedure. This case demonstrates that microsurgical treatment of a trigeminal AVM is feasible. However, stereotactic radiosurgery may be the preferred treatment option considering the potential for postoperative complications.
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  • Ampulla (Takotsubo) Cardiomyopathy Associated With Subarachnoid Hemorrhage Worsening in the Late Phase of Vasospasm
    —Case Report—
    Yasuki ONO, Tsuyoshi KAWAMURA, Jun ITO, Shigeaki KANAYAMA, Takeshi MIU ...
    2004 Volume 44 Issue 2 Pages 72-74
    Published: 2004
    Released on J-STAGE: March 07, 2005
    DOIhttps://doi.org/10.2176/nmc.44.72
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    A 66-year-old woman presented with subarachnoid hemorrhage(SAH) caused by a ruptured aneurysm of the left middle cerebral artery. Electrocardiography (ECG) disclosed abnormalities resembling acute myocardial infarction. She underwent neck clipping of the aneurysm uneventfully. Sixteen days after admission, ECG again disclosed abnormalities resembling acute myocardial infarction, and echocardiography suggested heart failure. Coronary angiography showed no abnormalities, but left ventriculography showed severe hypokinesia in the apex of the heart consistent with so-called ampulla (takotsubo) cardiomyopathy. The heart failure was treated with catecholamines and her heart function gradually recovered. Ampulla (takotsubo) cardiomyopathy associated with SAH requires careful management of heart function.
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  • Idiopathic Interdural Hematoma Looking Like a “Chinese Dumpling”
    —Case Report—
    Ken MIYAJIMA, Nakamasa HAYASHI, Masanori KURIMOTO, Naoya KUWAYAMA, Yut ...
    2004 Volume 44 Issue 2 Pages 75-76
    Published: 2004
    Released on J-STAGE: March 07, 2005
    DOIhttps://doi.org/10.2176/nmc.44.75
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    A 79-year-old man presented with an interdural hematoma manifesting as headache. Computed tomography revealed a right parietal intracranial hematoma. Magnetic resonance imaging revealed the hematoma had divided the dura mater into two layers. Craniotomy was performed and a dural pouch containing a solid hematoma was totally removed. Histological examination showed the hematoma had divided the meningeal dura into two layers. This case confirms the location of interdural hematoma.
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  • Ischemic Basilar Artery Dissecting Aneurysm Treated by Stenting Only
    —Case Report—
    Mohammad A. JAMOUS, Koichi SATOH, Shunji MATSUBARA, Junichiro SATOMI, ...
    2004 Volume 44 Issue 2 Pages 77-81
    Published: 2004
    Released on J-STAGE: March 07, 2005
    DOIhttps://doi.org/10.2176/nmc.44.77
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    A 45-year-old man presented with enlargement of basilar artery dissecting aneurysm 10 months after suffering brain stem infarction. Combined stenting and placement of Guglielmi detachable coils (GDCs) was planned to obliterate the aneurysm sac. Stent deployment was performed but the procedure was halted to avoid overdosing with contrast material. Cerebral angiography 10 days later showed thrombosis of the aneurysm sac and normalization of the blood flow in the basilar artery. The patient has been followed up for 2 years and showed good clinical and angiographic outcome. Stenting results in obliteration of the aneurysm sac, so a two-stage procedure is recommended.
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  • Cerebellar Hemorrhage Secondary to Cranial Metastasis of Prostate Cancer
    —Case Report—
    Joji INAMASU, Yoshiki NAKAMURA, Ryoichi SAITO, Yoshiaki KUROSHIMA, Kei ...
    2004 Volume 44 Issue 2 Pages 82-85
    Published: 2004
    Released on J-STAGE: March 07, 2005
    DOIhttps://doi.org/10.2176/nmc.44.82
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    A 77-year-old man with a 9-year history of prostate cancer presented with high fever and dysphagia. The initial diagnosis was aspiration pneumonia, but the patient became comatose 2 days after admission, and neuroradiological workup revealed cerebellar hemorrhage, obstructive hydrocephalus, and extensive destruction of the occipital bone secondary to cranial metastasis. The diagnosis was cerebellar hemorrhage secondary to cranial metastasis of prostate cancer. Tumor resection was abandoned because of the patient’s poor health. Shunt surgery and palliative radiotherapy were temporarily effective in restoring his consciousness, but he died of systemic infection 3 weeks after surgery. Metastasis of prostate cancer to the cranium, particularly to the skull base, rarely causes lower cranial nerve paresis, and awareness of this sign may lead to earlier detection of the cranial metastasis and prevention of cerebellar hemorrhage.
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  • Prolactinoma With a High Adrenocorticotropic Hormone Level Caused by Meningitis
    —Case Report—
    Satoshi UTSUKI, Hidehiro OKA, Satoshi TANAKA, Kazuhisa IWAMOTO, Hitomi ...
    2004 Volume 44 Issue 2 Pages 86-89
    Published: 2004
    Released on J-STAGE: March 07, 2005
    DOIhttps://doi.org/10.2176/nmc.44.86
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    A 69-year-old man was admitted semicomatose with high-grade fever and meningeal signs. Magnetic resonance imaging showed a supra- and intrasellar lesion. Hormone studies on admission showed increased serum prolactin, adrenocorticotropic hormone (ACTH), and cortisol titers. However, the serum ACTH and cortisol levels returned to normal after treatment of meningitis with an antimicrobial agent. The histological diagnosis was pituitary adenoma. Immunohistological staining showed positive reaction for prolactin but not for ACTH. This is a rare case of prolactinoma with a high serum ACTH level caused by meningitis.
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  • Supra- and Infratentorial Subdural Empyema Secondary to Septicemia in a Patient With Liver Abscess
    —Case Report—
    Atsuhiro KOJIMA, Noriyuki YAMAGUCHI, Shunichi OKUI
    2004 Volume 44 Issue 2 Pages 90-93
    Published: 2004
    Released on J-STAGE: March 07, 2005
    DOIhttps://doi.org/10.2176/nmc.44.90
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    An 81-year-old man presented with subdural empyema in the left parietotemporal convexity 2 months after treatment under diagnoses of liver abscess and septicemia. Systemic investigation found no evidence of otorhinological or other focal infection except for liver abscess. Emergency drainage of pus was performed via a single burr hole and additional intravenous antibiotics were administered. Six weeks later, magnetic resonance imaging revealed subdural empyema in the right cerebellopontine angle in addition to recurrence of pus in the left parietotemporal subdural space. Ischemic changes were also shown in the right cerebellar hemisphere and brainstem. Although subdural empyema secondary to septicemia is rare, the possibility of this type of intracranial infection must be kept in mind, especially in compromised patients with septicemia.
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Technical Note
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