Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 45, Issue 10
Displaying 1-11 of 11 articles from this issue
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Original Articles
  • Prevalence of Asymptomatic Microbleeds in Patients With Moyamoya Disease
    Tatsuya ISHIKAWA, Satoshi KURODA, Naoki NAKAYAMA, Satoshi TERAE, Kousu ...
    2005 Volume 45 Issue 10 Pages 495-500
    Published: 2005
    Released on J-STAGE: October 25, 2005
    DOIhttps://doi.org/10.2176/nmc.45.495
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    Basal moyamoya vessels are a potential source of hemorrhage in patients with moyamoya disease, but the etiology remains unclear. Symptomatic hemorrhage resulting from long-standing hemodynamic effects on pathologically dilated, fragile moyamoya vessels may be preceded by asymptomatic microbleeding in adult moyamoya disease patients, regardless of hemorrhagic or ischemic onset. T2*-weighted magnetic resonance (MR) imaging was used to investigate the presence of microbleeds in 27 adult patients with angiographically confirmed moyamoya disease, 21 females and six males aged 18-70 years (mean 40.8 ± 15.7 years). Clinical diagnosis was intracranial bleeding in six patients, transient ischemic attack or cerebral infarction in 18, and asymptomatic in three. Asymptomatic microbleeds were detected in four of the 27 patients, two of six who initially presented with hemorrhagic events and two of 18 with ischemic onset. These microbleeds were located in the paraventricular white matter, temporal subcortex, and basal ganglia. The presence of microbleeds had no correlation with either patient age or duration from disease onset or diagnosis of disease. A large cohort study is needed to explore the significance of asymptomatic microbleeds in moyamoya disease.
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  • Awake Surgery for Glioma Resection in Eloquent Areas
    —Zurich's Experience and Review—
    Naoki OTANI, Miroslava BJELJAC, Carl MUROI, Dorothea WENIGER, Nadia KH ...
    2005 Volume 45 Issue 10 Pages 501-511
    Published: 2005
    Released on J-STAGE: October 25, 2005
    DOIhttps://doi.org/10.2176/nmc.45.501
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    Awake surgery was performed in a series of 21 patients with gliomas in eloquent areas with the use of intraoperative electrical mapping. Gross total removal was performed in 18 patients. There was no operative mortality. Postoperative findings included no change in symptoms and signs in 10 patients, improvement of the preoperative deficit in 11 patients. Four patients had improved Karnofsky performance status (KPS) scores after surgery, 17 patients were stable, and no patient had lower KPS score. Extensive radical resection of gliomas prolongs the overall survival and improves the patient’s quality of life. However, surgical resection of gliomas located within the sensorimotor or language areas remains a neurosurgical challenge in reducing eloquent neurological sequelae. Awake surgery with intraoperative functional mapping is a safe approach to maximize the extent of tumor removal and to minimize the resultant neurological deficits in the treatment of glioma involving the eloquent cortex.
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  • Craniovertebral Junction Realignment for the Treatment of Basilar Invagination With Syringomyelia: Preliminary Report of 12 Cases
    Atul GOEL, Praveen SHARMA
    2005 Volume 45 Issue 10 Pages 512-518
    Published: 2005
    Released on J-STAGE: October 25, 2005
    DOIhttps://doi.org/10.2176/nmc.45.512
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    Twelve selected patients, eight males and four females aged 14 to 50 years, with syringomyelia associated with congenital craniovertebral bony anomalies including basilar invagination and fixed atlantoaxial dislocation, and associated Chiari I malformation in eight, were treated by atlantoaxial joint manipulation and restoration of the craniovertebral region alignment between October 2002 and March 2004. Three patients had a history of trauma prior to the onset of symptoms. Spastic quadriparesis and ataxia were the most prominent symptoms. The mean duration of symptoms was 11 months. The atlantoaxial dislocation and basilar invagination were reduced by manual distraction of the facets of the atlas and axis, stabilization by placement of bone graft and metal spacers within the joint, and direct atlantoaxial fixation using an inter-articular plate and screw method technique. Following surgery all patients showed symptomatic improvement and restoration of craniovertebral alignment during follow up from 3 to 20 months (mean 7 months). Radiological improvement of the syrinx could not be evaluated as stainless steel metal plates, screws, and spacers were used for fixation. Manipulation of the atlantoaxial joints and restoring the anatomical craniovertebral alignments in selected cases of syringomyelia leads to remarkable and sustained clinical recovery, and is probably the optimum surgical treatment.
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Case Reports
  • Subdural Hematoma Associated With Dural Metastasis
    —Case Report—
    Naoto KUNII, Akio MORITA, Gakushi YOSHIKAWA, Takaaki KIRINO
    2005 Volume 45 Issue 10 Pages 519-522
    Published: 2005
    Released on J-STAGE: October 25, 2005
    DOIhttps://doi.org/10.2176/nmc.45.519
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    A 56-year-old female presented with acute subdural hematoma associated with dural metastasis. The patient had been treated for breast cancer with disseminated bone and lung metastases. Evacuation of the hematoma with local management of the tumor and bleeding successfully improved her neurological condition and she underwent postoperative radiotherapy. This condition is especially associated with dural metastasis from adenocarcinoma (most frequently stomach cancer) and the clinical outcome depends on the general condition of the patient and the status of the coagulation disorders. If the tumors are multiple, as in this case, extreme caution should be paid to recurrent bleeding in the ipsilateral or contralateral side.
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  • Multiple Aneurysms Arising From the Posterior Inferior Cerebellar Artery With Unknown Etiology
    —Case Report—
    Tetsuhiro KITAHARA, Hiroshi YONEDA, Shouichi KATO, Kouji KAJIWARA, Tat ...
    2005 Volume 45 Issue 10 Pages 523-525
    Published: 2005
    Released on J-STAGE: October 25, 2005
    DOIhttps://doi.org/10.2176/nmc.45.523
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    A 67-year-old man presented with multiple aneurysms arising from the caudal loop of the posterior inferior cerebellar artery (PICA), possibly as a result of blunt trauma. Computed tomography of the head revealed subarachnoid hemorrhage in the posterior fossa and sylvian fissure. Repeated angiography demonstrated an aneurysmal dilatation and an irregular wall on the caudal loop of the PICA. Under the operating microscope, two lesions were observed 10 mm distal to the apex of the caudal loop, both consisting of a tiny hole on the vessel wall with a fragile fringe of connective tissue and covered with a firm clot. The height of the lesions corresponded to the C-l lamina, so the lesions were probably traumatic rather than saccular.
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  • Pseudocapsule Formation After Gamma Knife Radiosurgery for Trigeminal Neurinoma
    —Case Report—
    Takenori AKIYAMA, Eiji IKEDA, Takeshi KAWASE, Kazunari YOSHIDA
    2005 Volume 45 Issue 10 Pages 526-529
    Published: 2005
    Released on J-STAGE: October 25, 2005
    DOIhttps://doi.org/10.2176/nmc.45.526
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    A 38-year-old female presented with a trigeminal neurinoma manifesting as left facial paresthesia. The diagnosis was based on magnetic resonance (MR) imaging findings. Gamma knife radiosurgery (GKR) was performed at another hospital at her request. Fifteen months after the GKR, follow-up MR imaging revealed tumor regrowth causing extensive compression of the brainstem, and cyst formation in the tumor. Her clinical symptoms including facial pain and diplopia had worsened, so she was referred to our affiliated hospital for microsurgery. The tumor was totally resected, but the left trigeminal nerve had to be sacrificed because of pseudocapsule formation which covered both the tumor and the trigeminal nerve fibers. The diplopia disappeared, but her facial pain deteriorated after the operation. GKR can induce fibrosis or degenerative change in nearby structures, which may complicate subsequent surgery.
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  • Supratentorial Primitive Neuroectodermal Tumor in an Aged Patient
    —Case Report—
    Takashi SHINGU, Takato KAGAWA, Yoriyoshi KIMURA, Daikei TAKADA, Kouzo ...
    2005 Volume 45 Issue 10 Pages 530-535
    Published: 2005
    Released on J-STAGE: October 25, 2005
    DOIhttps://doi.org/10.2176/nmc.45.530
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    An 88-year-old woman presented with a supratentorial primitive neuroectodermal tumor (PNET) manifesting as disturbance of consciousness and left hemiplegia. Magnetic resonance imaging showed a large mass lesion in the right frontotemporal region. She underwent biopsy of the lesion that confirmed the diagnosis of PNET. Her poor condition only allowed chemotherapy with methyl 6-[3-(2-chloroethyl)-3-nitrosoureido]-6-deoxy-α-D-glucopyranoside (MCNU), vincristine, and prednisolone to be performed. The patient died approximately 6 months after diagnosis due to enlargement of the tumor. Supratentorial PNET is a rare tumor, especially in adults. Multimodal therapy consisting of gross total or subtotal resection, radiation therapy, and chemotherapy is generally considered necessary for patients with supratentorial PNET. However, the condition of each patient should be considered in determining the therapeutic plan, especially in the case of extremely aged patients, since supratentorial PNET is malignant and long-term survival is rare despite aggressive treatment.
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  • Bilateral Vocal Cord Paralysis in Newborns With Neuraxial Malformations
    —Two Case Reports—
    Hande GULCAN, Cagatay ONAL, Selda ARSLAN, Tuba BAYINDIR
    2005 Volume 45 Issue 10 Pages 536-539
    Published: 2005
    Released on J-STAGE: October 25, 2005
    DOIhttps://doi.org/10.2176/nmc.45.536
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    Two neonates presented with inspiratory stridor due to bilateral vocal cord paralysis associated with occipital encephalocele, Chiari malformation, and hydrocephalus in one patient, and cervical meningomyelocele and Chiari malformation in the other patient. The clinical symptoms dramatically regressed after repair of the encephalocele or meningomyelocele with no requirement for craniovertebral decompressive procedures or shunts in the acute phase. Careful evaluation of neonatal stridor and recognition of vocal cord paralysis are important, as treatment of associated congenital central nervous system anomalies is likely to achieve satisfactory surgical results.
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  • Spontaneous Cervical Paraspinal and Epidural Giant Abscess in a Child
    —Case Report—
    Nejmi KIYMAZ, Özgür DEMIR
    2005 Volume 45 Issue 10 Pages 540-542
    Published: 2005
    Released on J-STAGE: October 25, 2005
    DOIhttps://doi.org/10.2176/nmc.45.540
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    A 10-year-old girl presented with a very rare paraspinal and spinal epidural abscess manifesting as fever, and neck pain and stiffness. Initially, she was treated under a diagnosis of meningitis for 3 weeks. However, she developed monoparesis of the right upper extremity, and was referred for neurosurgery. Magnetic resonance imaging revealed an epidural and paraspinal lesion intensely enhanced by gadolinium. The patient underwent urgent surgery for C2-3 laminectomy and abscess drainage, followed by broad spectrum antibiotic therapy. She was discharged and followed up in the outpatient clinic. Two months later, the paraspinal abscess recurred with great increase in size. A second operation was performed and 150 ml pus was drained. Streptococcus anginosus was grown in the culture. The patient fully recovered after long-term targeted antibiotic therapy. Such abscesses are very rare in children, especially in the cervical region. The correct diagnosis can be difficult to establish but early treatment is essential for a good prognosis.
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  • Peritoneal Shunt Tube Migration Into the Stomach
    —Case Report—
    Jun MASUOKA, Toshihiro MINETA, Tomohiko KOHATA, Kazuo TABUCHI
    2005 Volume 45 Issue 10 Pages 543-546
    Published: 2005
    Released on J-STAGE: October 25, 2005
    DOIhttps://doi.org/10.2176/nmc.45.543
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    A 47-year-old man presented with repeated headache and feverishness 3.5 years after undergoing ventriculoperitoneal shunt surgery for normal pressure hydrocephalus secondary to subarachnoid hemorrhage. Abdominal computed tomography revealed that the peritoneal catheter was encased by fibrous tissue and the distal end of the catheter had migrated into the stomach. The diagnosis was spontaneous gastric perforation by the ventriculoperitoneal shunt. The fibrous tissue was expected to seal the very small gastric perforation, so the catheter was successfully extracted through a scalp incision without abdominal surgical intervention.
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Editorial Committee
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