Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 45, Issue 4
Displaying 1-9 of 9 articles from this issue
Original Articles
  • Yutaka HIRASHIMA, Masanori KURIMOTO, Nakamasa HAYASHI, Kimiko UMEMURA, ...
    2005 Volume 45 Issue 4 Pages 177-183
    Published: 2005
    Released on J-STAGE: April 25, 2005
    JOURNAL OPEN ACCESS
    The optimal duration of cerebrospinal fluid (CSF) drainage after acute aneurysm surgery is unclear. The association between the occurrence of symptomatic vasospasm or late hydrocephalus and the duration of CSF drainage was investigated using multiple logistic analysis in 95 consecutive patients with aneurysmal subarachnoid hemorrhage who underwent surgery within 72 hours after onset. The duration of drainage was significantly related to the occurrence of symptomatic vasospasm and late hydrocephalus. The cut-off values of the duration of drainage for preventing symptomatic vasospasm and late hydrocephalus were 11 days (adjusted odds ratio 0.347, 95% confidence interval 0.135-0.889, p = 0.0274) and 6 days (adjusted odds ratio 4.86, 95% confidence interval 1.46-16.2, p = 0.0099), respectively. Prevention of both symptomatic vasospasm and late hydrocephalus is not possible without additional procedures such as cisternal irrigation using fibrinolytic agents.
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  • Ibrahim M. ZIYAL, Tunçalp ÖZGEN, Laligam N. SEKHAR, Osman ...
    2005 Volume 45 Issue 4 Pages 184-191
    Published: 2005
    Released on J-STAGE: April 25, 2005
    JOURNAL OPEN ACCESS
    The nomenclature and borders of the segments of the internal carotid artery (ICA) remain confusing. A classification of segments of the ICA is proposed based on constant anatomical structures, such as the carotid foramen and canal, the petrous bone, the petrolingual ligament (PLL), and the proximal and distal dural rings. The bilateral ICAs were dissected in 15 cadaveric head specimens using different neurosurgical approaches. The bilateral lacerum foramina were studied in five dry skulls. The bilateral segments of the ICA were also examined on carotid angiograms of 10 normal patients and another with the ophthalmic artery originating from the intracavernous portion of the ICA. The present classification divides the ICA into five segments in the direction of the blood flow. The cervical segment is extradural and extracranial, the petrous segment is extradural and intraosseous, the cavernous segment is interdural and intracavernous, the clinoidal segment is interdural and paracavernous, and the cisternal segment is intradural and intracisternal. The ICA did not pass through the lacerum foramen in any specimen. In all specimens, 1/8 to 5/8 of the lacerum foramen was under the deep dural layer of the cavernous sinus. The term ‘lacerum segment’ as used previously and called the ‘trigeminal segment’ by us cannot be justified. The PLL is the posterolateral border of the cavernous sinus and the lacerum and trigeminal segments should be included in the cavernous and petrous segments. The ophthalmic artery may originate from the clinoidal ICA, from the cavernous ICA, or from the middle meningeal artery. Instead of using the term ‘ophthalmic segment,’ the term ‘cisternal segment’ should be used for the anatomically distinct ICA in the subarachnoid space. This classification should be minimally affected by anatomical variations.
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Case Reports
  • —Case Report—
    Satoru SHIMIZU, Ryusui TANAKA, Sumito SATO, Kiyotaka FUJII
    2005 Volume 45 Issue 4 Pages 192-195
    Published: 2005
    Released on J-STAGE: April 25, 2005
    JOURNAL OPEN ACCESS
    A 40-year-old male presented with hemifacial spasm manifesting as paroxysmal spontaneous twitches in the left peribuccal region persisting for 3 months. The symptoms began 7 days after an accident, when a signboard hit his left mandibular angle. Physical examination showed no trauma-related change in his face, and no neurological abnormality except for the twitches. Magnetic resonance imaging also showed no abnormalities of the facial nerve and adjacent regions. Electrophysiological studies showed synkinesis, so hemifacial spasm caused by peripheral facial nerve injury was suspect- ed. The symptoms subsided 4 months after the injury. Blunt injury to the facial nerve branches might cause hemifacial spasm.
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  • —Case Report—
    Ken-ichiro KIKUTA, Susumu MIYAMOTO, Tetsu SATOW, Hiroharu KATAOKA, Nob ...
    2005 Volume 45 Issue 4 Pages 196-200
    Published: 2005
    Released on J-STAGE: April 25, 2005
    JOURNAL OPEN ACCESS
    A 68-year-old woman presented with a large paraclinoid aneurysm with a calcified neck causing visual symptoms. Direct clipping was hazardous because of severe calcification of the neck. Endovascular internal trapping was difficult because of the short distance between the neck and the origin of the posterior communicating artery. Proximal occlusion was likely to be less effective because of large collateral back flow to the aneurysm via the ophthalmic artery (OphA). The aneurysm was successfully treated by a combination of a high-flow bypass, intraoperative coil embolization of the parent artery including the origin of the OphA, and clipping of the internal carotid artery distal to the aneurysm. Paraclinoid aneurysms may be difficult to treat by the simple application of direct clipping, endovascular coiling, or trapping. Multimodality procedures can be tailored to treat such aneurysms.
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  • —Case Report—
    Takeshi MIKAMI, Akira TAKAHASHI, Kiyohiro HOUKIN
    2005 Volume 45 Issue 4 Pages 201-204
    Published: 2005
    Released on J-STAGE: April 25, 2005
    JOURNAL OPEN ACCESS
    A 47-year-old man presented with carotid rete mirabile manifesting as subarachnoid hemorrhage (SAH). Computed tomography showed SAH, and angiography disclosed an abnormal vascular network around the petrous and cavernous portions of the internal carotid artery. Single photon emission computed tomography (SPECT) with technetium-99m methyl cysteinate dimer revealed reduced regional cere- bral blood flow (CBF). Twelve months later, he was leading a normal life without neurological problems, hemorrhage, or ischemic manifestations. SPECT with iodine-123 N-isopropyl-p-iodoamphetamine and the acetazolamide challenge test showed the CBF had normalized.
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  • —Case Report—
    Ismail AKDEMIR, Fatih S. EROL, Nusret AKPOLAT, M. Faik OZVEREN, Murat ...
    2005 Volume 45 Issue 4 Pages 205-208
    Published: 2005
    Released on J-STAGE: April 25, 2005
    JOURNAL OPEN ACCESS
    A 57-year-old male patient presented with an immobile ellipsoid mass of 6-cm diameter in the right occipitoparietal region. Cranial computed tomography showed the mass with dense contrast enhancement causing bone destruction. After embolization of the mass, total resection was performed. Histological examination showed the mass had a capsule, with no invasion of the dura mater or dermis, and the follicles of various sizes covered with mono-lined thyrocytes were full of colloid. Immunohistochemical examination showed positive staining for thyroglobulin. Postoperatively, levels of thyroid hormones were normal, and thyroid ultrasonography and technetium-99m scintigraphy showed no abnormalities. Fine needle aspiration biopsy performed at various locations of the thyroid gland revealed no atypical thyroid cells. Whole body technetium-99m scintigraphy found no abnormal bone involvement. The histological evidence was suggestive of follicular carcinoma metastasis. Surgical treatment was planned for the thyroid gland, but the patient did not consent. Two years later, the patient presented with the pain and sensitivity in the sacrum, the right iliac wing, and the right caput femoris. Computed tomography revealed lytic lesions in these areas. Bone metastases were identified. Whole body scintigraphy showed increased activity in these regions, but the cranium and all other tissues were normal. The patient underwent total thyroidectomy under a diagnosis of follicular carcinoma. The present case of a lytic skull lesion associated with normal thyroid tissue on admission but finally treated as follicular thyroid cancer emphasizes the difficulty in histological discrimination of follicular carcinoma from normal thyroid tissue.
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  • —Case Report—
    Mehmet TURGUT, Orhan AKYÜZ, Yelda ÖZSUNAR, Füruzan KACA ...
    2005 Volume 45 Issue 4 Pages 209-211
    Published: 2005
    Released on J-STAGE: April 25, 2005
    JOURNAL OPEN ACCESS
    A 45-year-old woman presented with complaints of low back pain and sciatica on the left persisting for 2 years. She had undergone left hemilaminectomy and discectomy for L4-5 intervertebral disc herniation at another medical center. Spinal computed tomography and magnetic resonance (MR) imaging revealed a mass lesion in the posterior paravertebral region. The mass was hypointense with ring enhancement on the T1-weighted images and hyperintense on the T2-weighted images. Surgery found a retained sponge within the paraspinal mass cavity which was removed totally. Foreign-body granuloma (“gauzoma”) induced by forgotten sponge material is not an unusual complication of posterior lumbar surgery and should be considered as a potential cause in cases of surgical wound infections. MR imaging is essential to achieve the correct differential diagnosis.
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  • —Case Report—
    Junichi MIZUNO, Hiroshi NAKAGAWA, Tatsushi INOUE, Yoshio HASHIZUME
    2005 Volume 45 Issue 4 Pages 212-215
    Published: 2005
    Released on J-STAGE: April 25, 2005
    JOURNAL OPEN ACCESS
    A previously healthy 45-year-old woman presented with ligamentum flavum hematoma manifesting as radicular leg pain. Neurological examination findings were consistent with L-5 root compression. An old hematoma inside the degenerated ligamentum flavum was drained. The cyst showed no connection to the facet joint. Complete resection of the mass was performed, resulting in excellent pain relief. The most common cystic lesion in the lumbar spine is synovial cyst associated with the facet joints, but ligamentum flavum hematoma should be included in the differential diagnosis. The preoperative diagnosis can be based on computed tomography and magnetic resonance imaging findings of degenera- tive thickening of the ligamentum flavum associated with a fluid component.
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  • —Case Report—
    Kunikazu KUROSAKI, Nakamasa HAYASHI, Hideo HAMADA, Emiko HORI, Masanor ...
    2005 Volume 45 Issue 4 Pages 216-219
    Published: 2005
    Released on J-STAGE: April 25, 2005
    JOURNAL OPEN ACCESS
    A 22-year-old woman presented with a rare case of multiple epidermoid cysts located in the pineal and extracranial regions. Magnetic resonance (MR) imaging showed a lesion in the pineal region as hypointense on the T1-weighted image and hyperintense on the T2-weighted image, without enhancement. Neuroendoscopic treatment was performed under a diagnosis of pineal cyst. However, the cyst wall was too thick to perforate, although third ventriculostomy was performed. Diffusion-weighted MR imaging demonstrated the lesions in the pineal and extracranial regions as marked hyperintensity. The diagnosis was epidermoid cyst. Subsequently, neuroendoscopic treatment of the pineal epidermoid cyst was performed. Careful preoperative diagnosis of epidermoid cysts based on diffusion-weighted MR imaging is required.
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