Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 46, Issue 12
Displaying 1-11 of 11 articles from this issue
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Original Articles
  • Final Report of the Japan Neurotrauma Data Bank Project 1998-2001: 1,002 Cases of Traumatic Brain Injury
    Norio NAKAMURA, Akira YAMAURA, Minoru SHIGEMORI, Takeki OGAWA, Takashi ...
    2006 Volume 46 Issue 12 Pages 567-574
    Published: 2006
    Released on J-STAGE: December 22, 2006
    DOIhttps://doi.org/10.2176/nmc.46.567
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    A 4-year study (Japan Neurotrauma Data Bank) of the medical treatment of 1002 cases of traumatic brain injuries in Japan was conducted from 1998 to 2001 at 10 emergency medical centers. Patients with severe head injury were eligible for entry with a Glasgow Coma Scale score of 8 or less at admission. Patients who underwent craniotomy were also included. Children under 5 years old were excluded. An original data sheet with 392 items from multi-focal viewpoints, such as etiology of injury, pre-hospital care, initial treatment including neuro-intensive care unit, and surgical treatment, was created. The results show that the patient’s age and mechanism of injury are the most important factors in the outcome.
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  • Distal Anterior Cerebral Artery Aneurysms
    —Report of 26 Cases—
    Cem DINC, Ahmet Celal IPLIKCIOGLU, Kerem BIKMAZ
    2006 Volume 46 Issue 12 Pages 575-580
    Published: 2006
    Released on J-STAGE: December 22, 2006
    DOIhttps://doi.org/10.2176/nmc.46.575
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    Distal anterior cerebral artery (ACA) aneurysms are rare, and constitute approximately 1.5% to 9% of all intracranial aneurysms. They show some unique features compared with other aneurysms in the cerebral circulation and are frequently treated with a different technique. Twenty-six of 364 patients with cerebral aneurysms treated at our department between 1996 and 2004 had distal ACA aneurysms (7.1%). Twenty-three of the 26 patients were treated through an anterior interhemispheric approach and two with a pterional approach. All saccular aneurysms were successfully clipped except one which was embolized after the surgery. The only fusiform aneurysm spontaneously thrombosed and resolved with parent artery occlusion. Two of the 26 patients had multiple aneurysms. The surgical mortality was 8%. Distal ACA aneurysms have higher mortality and morbidity than other anterior circulation aneurysms. They should be aggressively treated even if very small because of the tendency to rupture. Endovascular treatment is an alternative in the management of these aneurysms. The most important factors affecting the outcome are grade on admission and the neurosurgeon’s experience.
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  • Perfusion-Weighted Magnetic Resonance Imaging of the Spinal Cord in Cervical Spondylotic Myelopathy
    Kazuya UEMURA, Akira MATSUMURA, Tomonori ISOBE, Izumi ANNO, Hiraku KAW ...
    2006 Volume 46 Issue 12 Pages 581-588
    Published: 2006
    Released on J-STAGE: December 22, 2006
    DOIhttps://doi.org/10.2176/nmc.46.581
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    Principles of echo shifting with a train of observations was used to perform magnetic susceptibility-weighted magnetic resonance imaging with bolus-tracking in 14 patients with spondylotic myelopathy to assess changes in perfusion parameters of the spinal cord before and after decompression surgery for cervical spondylotic myelopathy. The mean transit time (MTT), bolus arrival time (T0), and time to peak (TTP) were obtained from regions of interest (ROIs) and assessed as the ratio between the spinal cord and the pons (MTT index = MTTROI/MTTpons, T0 index = T0ROI/T0pons, TTP index = TTPROI/TTPpons). The patients were divided into two groups according to percentage improvement on the Neurosurgical Cervical Spine Scale. The MTT index in patients with good recovery (≥50%) was significantly reduced. The T0 index and TTP index showed no significant change in both groups. Reduction of MTT index may indicate improved perfusion of the spinal cord following surgery for cervical spondylotic myelopathy.
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Case Reports
  • Cerebral Venous Sinus Thrombosis Associated With Iron Deficiency
    —Two Case Reports—
    Yusuke KINOSHITA, Seijiro TANIURA, Hisashi SHISHIDO, Takeo NOJIMA, Hid ...
    2006 Volume 46 Issue 12 Pages 589-593
    Published: 2006
    Released on J-STAGE: December 22, 2006
    DOIhttps://doi.org/10.2176/nmc.46.589
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    Two patients presented with cerebral venous sinus thrombosis (CVST) associated with iron deficiency. A 14-year-old man had thrombosis extending from the end of the superior sagittal sinus to the left transverse sinus. Severe dehydration after competitive sport had induced CVST. The laboratory findings showed severe iron deficiency anemia which persisted for 1 year. A 47-year-old man had thrombosis in the entire superior sagittal sinus. Dehydration caused by poor nutrition had induced CVST. The laboratory findings showed transient iron deficiency in the acute phase. Both patients received conservative treatment for dehydration and iron supplementation. These two cases indicate that iron deficiency is a risk factor for CVST.
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  • Pituitary Apoplexy Manifesting as Diffuse Subarachnoid Hemorrhage
    —Case Report—
    Kuniaki NAKAHARA, Hidehiro OKA, Satoshi UTSUKI, Hideo IIDA, Mari KURIT ...
    2006 Volume 46 Issue 12 Pages 594-597
    Published: 2006
    Released on J-STAGE: December 22, 2006
    DOIhttps://doi.org/10.2176/nmc.46.594
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    A 46-year-old woman presented with hemorrhage from a non-functioning pituitary adenoma manifesting as sudden onset of severe headache. Computed tomography demonstrated diffuse subarachnoid hemorrhage (SAH) and a suprasellar mass with intratumoral hematoma. The patient underwent transnasal transsphenoidal removal of the pituitary adenoma. This type of SAH with intratumoral hematoma simulates rupture of an anterior cerebral artery aneurysm.
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  • Ectopic Recurrence of Craniopharyngioma
    —Case Report—
    Yuji YAMADA, Jo HARAOKA, Jiroh AKIMOTO
    2006 Volume 46 Issue 12 Pages 598-600
    Published: 2006
    Released on J-STAGE: December 22, 2006
    DOIhttps://doi.org/10.2176/nmc.46.598
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    A 27-year-old woman presented with ectopic recurrence manifesting as an asymptomatic mass in the left frontal convexity 5 years after subtotal removal of suprasellar craniopharyngioma through a right orbitozygomatic craniotomy. The mass had enlarged gradually over the next 5 years, so a second operation was performed for total removal. The histological diagnoses of both lesions were adamantinomatous type craniopharyngioma with MIB-1 indexes of 4.2% and 7.4%. The second lesion probably resulted from dissemination. Craniopharyngioma is a benign tumor, and ectopic recurrence is rare. Long-term clinical and neuroimaging follow up is recommended.
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  • Spontaneous Regression of a Growing Vestibular Schwannoma
    —Case Report—
    Yukimasa YASUMOTO, Masanori ITO
    2006 Volume 46 Issue 12 Pages 601-604
    Published: 2006
    Released on J-STAGE: December 22, 2006
    DOIhttps://doi.org/10.2176/nmc.46.601
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    A 75-year-old woman presented with a small right vestibular schwannoma which enlarged and then spontaneously regressed during conservative management. The tumor increased in size from 5.2 to 16.7 mm over 7 years with worsening symptoms of tinnitus, dizziness, and headache. The tumor then regressed to 8.2 mm and the symptoms improved for 4 years without further treatment. Changes in tumor growth should be carefully monitored during conservative management of patients with vestibular schwannoma.
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  • Third Ventricular Chordoid Glioma With Unusual Aggressive Behavior
    —Case Report—
    Tae-Young JUNG, Shin JUNG
    2006 Volume 46 Issue 12 Pages 605-608
    Published: 2006
    Released on J-STAGE: December 22, 2006
    DOIhttps://doi.org/10.2176/nmc.46.605
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    A 50-year-old woman presented with a rare chordoid glioma manifesting as an approximately 4-year history of decreased cognitive function and recent decreased visual acuity. Magnetic resonance imaging showed a 4.5 × 3.5 cm multilobulated strongly enhanced mass in the suprasellar cistern and third ventricle associated with hydrocephalus. The tumor was subtotally removed via a transcallosal approach. Histological examination showed chordoid glioma. Two months later, ventriculoperitoneal shunting was performed for hydrocephalus. The tumor and hydrocephalus recurred after 3 months. She died after 4 months because of deepened mentality and combined pneumonia. This very short duration before recurrence suggests that neuroimaging follow up may be necessary in patients with subtotally removed choroid glioma.
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  • Skull Metastases From Atypical Pulmonary Carcinoid Tumor in a 19-Year-Old Man
    —Case Report—
    Toshihiko ISAKA, Motohiko MARUNO, Tsuyoshi SUZUKI, Masaharu SATO, Tosh ...
    2006 Volume 46 Issue 12 Pages 609-613
    Published: 2006
    Released on J-STAGE: December 22, 2006
    DOIhttps://doi.org/10.2176/nmc.46.609
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    A 19-year-old man presented with a rare skull metastasis from atypical pulmonary carcinoid tumor (APCT) manifesting as headache, diplopia, and cough. Head magnetic resonance imaging showed a skull base tumor extending from the posterior clinoid process to the clivus, and calvarial tumors in the right temporal and occipital bones. Chest and abdominal computed tomography showed a round tumor, 4 cm in diameter, in the lower lobe of the right lung and multiple small tumors in the liver. Surgery for the calvarial tumor in the right temporal bone was performed on June 27, 2003. The histological diagnosis was skull metastasis of neuroendocrine tumor. Gamma knife radiosurgery was performed for the residual skull metastases. Partial resection of the right lower lobe was performed for the lung tumor on August 22, 2003. The histological diagnosis was atypical carcinoid tumor. Subsequent adjuvant systematic chemotherapy was performed. The patient died of progression of the tumors in the lung and liver on April 19, 2004. We must consider APCT in the differential diagnosis of pulmonary tumors in adolescents, and perform follow-up observation or treatment, including surgery, if APCT is suspected.
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  • Endodermal Cyst Ventral to the Lower Brain Stem
    —Case Report—
    Shigeo MATSUNAGA, Kazuhiko FUJITSU, Saburo YAGISHITA, Teruo ICHIKAWA, ...
    2006 Volume 46 Issue 12 Pages 614-618
    Published: 2006
    Released on J-STAGE: December 22, 2006
    DOIhttps://doi.org/10.2176/nmc.46.614
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    A 28-year-old woman presented with a rare case of endodermal cyst located ventral to the lower brain stem manifesting as recurrent aseptic meningitis. Computed tomography and magnetic resonance imaging demonstrated a cystic mass located ventral to the lower brain stem and extending from the prepontine to the upper cervical (C-2) cistern. The lesion was totally removed through a retrosigmoid craniotomy and C1-2 hemilaminectomy. Histological and immunohistochemical examination showed the cyst was derived from the endoderm. The histological diagnosis was endodermal cyst. Early diagnosis and surgical removal are important for patients with these cysts.
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Editorial Committee
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