Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 46, Issue 10
Displaying 1-11 of 11 articles from this issue
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Original Articles
  • Increased Regional Interleukin-4 During the Acute Stage of Severe Intracranial Disorders
    Makoto KATSUNO, Hiroyuki YOKOTA, Yasuhiro YAMAMOTO, Akira TERAMOTO
    2006 Volume 46 Issue 10 Pages 471-475
    Published: 2006
    Released on J-STAGE: October 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.471
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    Interleukin (IL)-4 levels in the internal jugular vein were measured during the acute stage in patients with head injuries, subarachnoid hemorrhage, or intracerebral hemorrhage to investigate the prognostic value. Levels of IL-4, interferon (IFN)-γ, glucose, and lactate, and oxygen saturation were measured in the internal jugular vein to investigate cerebral local reactions and in the radial artery as a control at admission and 4 hours after onset. The subjects were divided into a survival group and a deceased group. IL-4 levels were high in the internal jugular veins and arterio-jugular venous differences in oxygen content (AjDO2) were low at 4 hours after onset in the deceased group. Increased glucose and lactate levels were found at 4 hours after onset in the deceased group. No significant difference was found for IFN-γ. The severity of cerebral disorders evaluated using AjDO2 showed a negative correlation with intracerebral IL-4 level. This finding suggests that secretion of IL-4, which has a neuroprotective effect, may increase with the severity of neuropathy and may be useful as a prognostic index.
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  • Evaluation of Merci Retriever by Experimental Modeling
    Yasuhiro SUZUKI, Mitsuyuki FUJITSUKA, John C. CHALOUPKA
    2006 Volume 46 Issue 10 Pages 476-484
    Published: 2006
    Released on J-STAGE: October 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.476
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    The Merci Retriever is the first device for mechanical embolus removal in patients with cerebral ischemia. Use of the device was evaluated using experimental models. Three stroke model systems were created: silicone embolism model with flow system, pig embolism model, and silicone-pig tortuous artery model. The series of extraction procedures (capture, retrieval, and aspiration) was examined in the models under flow control. Coagulated blood clot was adopted as embolic material, to simulate embolic stroke of the carotid or middle cerebral arteries. Retrieval of the clot was successful in only one of six trials in the silicone model of the carotid artery, as the clot easily worked free from the helical tip. Aspiration was successful in three of the six trials. Retrieval was successful in two of four trials in the middle cerebral artery and aspiration was successful in two. Retrieval was successful in all five trials in the pig embolism model, and three of five trials in the silicone-pig tortuous artery model. The Merci Retriever does not always retain the embolism, and the helix tends to distort in acute or rough lumen. Aspiration is not always successful.
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  • Treatment of Neoplastic Meningitis With Intrathecal 9-Nitro-camptothecin
    Hidenobu OCHIAI, Chris T. PERNELL, Gary E. ARCHER, Tracy A. CHEWNING, ...
    2006 Volume 46 Issue 10 Pages 485-490
    Published: 2006
    Released on J-STAGE: October 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.485
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    The topoisomerase I inhibitor, 9-nitro-camptothecin (9NC), is highly tumoricidal against glioblastoma multiforme (GBM) in vitro. However, systemic administration of 9NC has not shown the expected efficacy in clinical trials. This failure may be due to the rapid hydrolysis of 9NC in plasma from the active form to the inactive and myelosuppressive form in the presence of human albumin at physiologic pH. Concurrent treatment with anticonvulsants and dexamethasone, drugs indispensable for the supportive therapy of patients with GBM, has also been shown to decrease plasma concentrations of these drugs. Intrathecal drug delivery circumvents the blood-brain barrier and minimizes systemic toxicity. Intrathecal delivery of 9NC may also have the more specific advantage of significantly reducing the hydrolysis of 9NC that occurs after systemic delivery due to the more favorable pH and reduced albumin content in cerebrospinal fluid. The present study evaluated the toxicity and efficacy of intrathecal delivery of 9NC in an athymic rat model of neoplastic meningitis. Toxicity tests showed that 0.3 μmol (5000 μM), 0.03 μmol (500 μM), 0.003 μmol (50 μM), or 0.0003 μmol (5 μM) of 9NC administered intrathecally to the athymic rats caused no evidence of clinical or histological toxicity. Intrathecal administration of 0.3 μmol (5000 μM) of 9NC twice a week for three doses to athymic rats with neoplastic meningitis induced by the GBM cell line, U87MGΔEGFR, resulted in a 26% increase of median survival compared to the control group (p < 0.005). These results suggest that intrathecal treatment with 9NC may be useful for patients with GBM neoplastic meningitis.
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Case Reports
  • Hypothalamic Hamartoma Associated With Anterior Paraclinoid Aneurysm of the Internal Carotid Artery
    —Case Report—
    Koichi KATO, Fumitaka YAMANE, Motohiro HAYASHI, Hidetoshi KASUYA, Yosh ...
    2006 Volume 46 Issue 10 Pages 491-494
    Published: 2006
    Released on J-STAGE: October 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.491
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    A 15-year-old boy presented with a history of medically refractory gelastic seizures and cognitive impairments. Neuroimaging demonstrated a sessile type hypothalamic hamartoma, which was treated by gamma knife surgery. However, the gelastic seizures only partially decreased and the frequency of seizures remained unchanged. One year later, angiography before surgery detected anterior paraclinoid aneurysm of the left internal carotid artery. Blood pressure and endocrinological examinations showed no abnormality. Direct surgery was performed to treat the aneurysm and hamartoma. No sclerotic changes were noted in the arterial wall. The aneurysm was treated with clipping, and the hamartoma was partially removed. Postoperative course was uneventful and the gelastic seizures disappeared. No evidence for a causal relationship between the hamartoma and aneurysm was found.
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  • Successful Recanalization by In-Stent Percutaneous Transluminal Angioplasty With Distal Protection for Acute Carotid Stent Thrombosis
    —Case Report—
    Osamu MASUO, Tomoaki TERADA, Yoshikazu MATSUDA, Mitsuhiro OGURA, Tomoy ...
    2006 Volume 46 Issue 10 Pages 495-499
    Published: 2006
    Released on J-STAGE: October 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.495
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    A 71-year-old male presented with severe left cervical internal carotid artery stenosis manifesting as repeated transient ischemic attacks consisting of right hemiparesis and motor aphasia. Carotid artery stenting (CAS) under distal protection was performed to prevent further ischemic events. This procedure was uneventful. However, the patient exhibited progressive right hemiparesis and motor aphasia 3 days after CAS. Emergent angiography revealed carotid artery occlusion due to in-stent thrombosis. In-stent percutaneous transluminal angioplasty (PTA) was performed under distal protection. The carotid artery was recanalized with small residual thrombus. The neurological deficits almost completely disappeared after PTA. Follow-up angiography 9 months after stenting showed restenosis but no in-stent thrombosis. Carotid thrombosis after CAS can be resolved by in-stent PTA under distal protection and subsequent treatment with antithrombotic agents.
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  • Surgical Decision for Adult Optic Glioma Based on [18F]Fluorodeoxyglucose Positron Emission Tomography Study
    —Case Report—
    Junichi MIYAMOTO, Hiroyasu SASAJIMA, Kei OWADA, Katsuyoshi MINEURA
    2006 Volume 46 Issue 10 Pages 500-503
    Published: 2006
    Released on J-STAGE: October 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.500
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    A 51-year-old male presented with a 5-year history of progressive right exophthalmos and visual loss. Magnetic resonance imaging showed a right intraorbital lesion. [18F]fluorodeoxyglucose positron emission tomography ([18F]FDG-PET) revealed high uptake in the tumor. No FDG was accumulated in the remaining optic tract. He underwent removal of the tumor. The histological diagnosis was optic glioma. Six months after the operation, the tumor recurred, and a second operation was performed to spare the visual acuity of the other eye, which remained stable for 1.5 years after the first operation. However, the patient died 2 years after the first operation of liver dysfunction. Adult optic glioma tends to rapidly extend into the surrounding tissue and to affect the contralateral visual pathway. Early diagnosis and surgical intervention are imperative. In the present case, [18F]FDG-PET was valuable for evaluating malignancy to determine whether radical surgery was indicated to preserve the remaining visual acuity.
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  • Effect of Gefitinib on Brain Metastases From Non-Small Cell Lung Cancer
    —Two Case Reports—
    Noriyuki NISHI, Shozo KAWAI, Taiji YONEZAWA, Kenta FUJIMOTO, Katsuya M ...
    2006 Volume 46 Issue 10 Pages 504-507
    Published: 2006
    Released on J-STAGE: October 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.504
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    Two patients with non-small cell lung cancer presented with multiple brain metastases. They received gefitinib orally for the treatment of the primary lung lesions. About one month later, the brain metastases unexpectedly disappeared or became smaller. The patients survived without recurrence of brain metastases and growth of lung lesions for 3-4 years. Gefitinib is a selective epidermal growth factor receptor tyrosine kinase inhibitor and is approved for use in the treatment of non-small cell lung cancer. Gefitinib may be very effective for multiple brain metastases in patients with non-small cell lung cancer.
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  • Osteoma Arising From the Lumbar Articular Process
    —Case Report—
    Hayato KOBAYASHI, Jun HARA, Yoshihiro KITAHAMA, Junya HANAKITA
    2006 Volume 46 Issue 10 Pages 508-511
    Published: 2006
    Released on J-STAGE: October 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.508
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    A 57-year-old man presented with an extremely rare osteoma originating from the left L-5 inferior articular process and causing lumbo-crural sciatica. Postmyelography computed tomography and magnetic resonance imaging showed an osteoma compressing the spinal nerve root at the lateral recess. Decompression facetectomy and excision of the lesion followed by transforaminal lumbar interbody fusion between L-5 and S-1 provided complete relief from the symptoms. Histological examination confirmed the diagnosis of benign osteoma. The previous seven cases of spinal osteoma involved the vertebral body, pedicle and posterior elements. Spinal osteomas should be considered in the differential diagnosis of benign lesion originating from the articular process.
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  • Spontaneous Resolution of Syringomyelia Without Chiari Malformation
    —Case Report—
    Pinar Akdemir OZISIK, Burcu HAZER, Ibrahim M. ZIYAL, Osman Ekin OZCAN
    2006 Volume 46 Issue 10 Pages 512-517
    Published: 2006
    Released on J-STAGE: October 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.512
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    A 30-year-old woman presented with a cervical syrinx manifesting as hemihypesthesia. Neuroimaging found no evidence of Chiari malformation or tight cisterna magna. Serial magnetic resonance imaging studies over a 6-year period demonstrated spontaneous and complete resolution of the syrinx accompanied by an asymptomatic clinical course. The natural history of syringomyelia is highly unpredictable. The outcome of surgical treatment for patients with syringomyelia is not always satisfactory, so the indications for surgery are controversial. Spontaneous resolution of syringomyelia unrelated with foramen magnum lesion has various causes. Close follow up of the patient is necessary to monitor for recurrence.
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  • False Lateralization of Mesial Temporal Lobe Epilepsy by Noninvasive Neurophysiological Examinations
    —Case Report—
    Ayataka FUJIMOTO, Hiroshi MASUDA, Jumpei HOMMA, Mutsuo SASAGAWA, Shige ...
    2006 Volume 46 Issue 10 Pages 518-521
    Published: 2006
    Released on J-STAGE: October 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.518
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    Mesial temporal lobe epilepsy (mTLE) is the most common form of symptomatic localization-related epilepsy and is surgically remediable. Lateralization of the seizure onset is particularly important to determine from a surgical perspective. A 39-year-old woman with intractable mTLE first exhibited seizure at the age of 3 years. She experienced epigastric sensation and placed her right hand on her abdomen before falling backward. Although interictal scalp electroencephalography (EEG), sphenoidal scalp ictal EEG, and magnetoencephalography showed right temporal side focus, computed tomography and magnetic resonance imaging showed atrophy of the left cerebral hemisphere. Single photon emission computed tomography with technetium-99m ethyl cysteinate dimmer and I-123 iomazenil showed obscure focus on the left side. As a discrepancy existed between the results of neurophysiological examinations and imaging, we performed subdural electrode implantation on the bilateral temporal lobe. Although a bemegride-induced seizure arose from the right side during the subdural recording, the onset of 5 habitual seizures was observed in the left hippocampus. On the basis of these results, the seizure was diagnosed as left mTLE, and left anterior temporal lobectomy and amygdalohippocampectomy were performed. The patient has been free from the seizures for more than 1.5 years of follow up. Bilateral subdural electrode measurement of habitual seizures is indispensable for clarifying the actual focus when a discrepancy exists between neuroimaging and noninvasive neurophysiological examinations.
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Editorial Committee
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