Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 46, Issue 2
Displaying 1-14 of 14 articles from this issue
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Review Articles
  • Shaken Baby Syndrome: An Odyssey
    Ronald H. USCINSKI
    2006 Volume 46 Issue 2 Pages 57-61
    Published: 2006
    Released on J-STAGE: February 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.57
    JOURNAL OPEN ACCESS
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    Shaken baby syndrome is evaluated in the context of its historical evolution and its veracity in referring to causal injury mechanisms. A rational assessment of the injury causation and consequent pathological states associated with the syndrome is presented. It is now evident that shaken baby syndrome evolved as a result of a faulty application of scientific reasoning and a lack of appreciation of mechanisms of injury. A brief explanation of the commonly understood usage and interface of scientific methodology and reasoning as applied to clinical medicine is given.
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  • Prevention and Management of Painful Neuroma
    Joanna LEWIN-KOWALIK, Wieslaw MARCOL, Katarzyna KOTULSKA, Marek MANDER ...
    2006 Volume 46 Issue 2 Pages 62-68
    Published: 2006
    Released on J-STAGE: February 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.62
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    Painful neuroma is a common sequela of peripheral nerve injury which is usually resistant to pharmacologic treatment and requires surgical intervention. The widely accepted methods of neuroma management prevent regrowth of nerve fibers, thus precluding any functional repair. The present study reviews the currently used methods and experimental approaches to prevent and cure neuromas developing after peripheral nerve injury. The main recommendations are as follows. Special care should be taken to minimize scar formation when operating on peripheral nerves. The laser or scissors transection methods should be used to cut the nerve rather than electrocoagulation or cryoneurolysis. Direct nerve reconstruction, or, if a gap occurs, nerve grafting, should be performed immediately after nerve injury. Surgical resection of recurrent neuroma followed by implantation of the nerve into the muscle or capping the nerve stump with epineural graft seems to be the most effective method of prevention.
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Original Article
  • Novel Approach to Calvarial Bone Transport Using a Rabbit Model
    Nobuo HIRANO, Michiharu TANABE, Takashi WATANABE, Yasushi HORIE, Hiden ...
    2006 Volume 46 Issue 2 Pages 69-74
    Published: 2006
    Released on J-STAGE: February 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.69
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    Calvarial defects sometimes require cranioplasty to protect the brain. Alloplastic materials, such as acrylic resin, hydroxyapatite ceramics, and titanium, involve various problems, such as vulnerability, infection, deformity resulting from growth, and high cost. We devised a new bone transport model in the rabbit based on the distraction osteogenesis theory of Ilizarov. Twelve Japan white rabbits with a mean body weight of 2.5 kg aged 12 weeks were used. Craniectomy (7 × 14 mm) was performed in 12 rabbits. Trapezoid bone osteotomy was performed anterior to the calvarial defect in 10 rabbits. The distraction device (Extension-plates®) was fixed between the trapezoid bone island and the skull. Distraction was initiated 5 days postoperatively. The device was activated once every other day, with approximately 0.75 mm or 0.5 mm per activation. Bone distraction was continued until the rod could not be moved. The lengths of distraction were 4 mm in two cases, 5 mm in one case, 6 mm in one case, and 7 mm in two cases, with a mean of 5.5 ± 0.56 mm. Both radiographic and histological findings showed osteogenesis by intramembranous ossification and trans-chondroid bone formation. Distraction osteogenesis has potential clinical applications in cranioplasty, especially in children because usage of autogenous bone is difficult if not impossible in most cases.
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Case Reports
  • Hypertensive Brainstem Encephalopathy Without Parieto-occipital Lesion
    —Two Case Reports—
    Yoshimitsu DOI, Fumiharu KIMURA, Tohru FUJIYAMA, Chieko FUJIMURA, Taku ...
    2006 Volume 46 Issue 2 Pages 75-79
    Published: 2006
    Released on J-STAGE: February 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.75
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    Two patients presented with malignant hypertension associated with encephalopathy predominantly manifesting as brainstem lesion. T2-weighted and fluid-attenuated inversion recovery magnetic resonance (MR) imaging revealed diffuse hyperintense areas in the pons and scattered lesions in the cerebellum, basal ganglia, and cerebral subcortex without parieto-occipital lesions. Diffusion-weighted MR imaging demonstrated these lesions as normal intensity, indicating vasogenic edema. These lesions resolved rapidly once hypertension was controlled. Review of clinical findings for 14 other patients with hypertensive brainstem encephalopathy without parieto-occipital lesions suggested that anterior circulation structures supplied by the carotid artery are frequently involved in such patients.
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  • Caseous Necrotic Granuloma in the Pituitary Stalk Due to Nontuberculous Mycobacteria (Mycobacterium Tokaiense) Infection
    —Case Report—
    Akihide KONDO, Kentaro MORI, Junko IWATA, Masaru TAMURA, Takuji YAMAMO ...
    2006 Volume 46 Issue 2 Pages 80-83
    Published: 2006
    Released on J-STAGE: February 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.80
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    A 36-year-old man with no history of immunosuppression presented with diabetes insipidus, but no other hormonal disturbances. Magnetic resonance imaging of the brain revealed an enhanced mass in the pituitary stalk appearing as a thickened pituitary stalk. The mass lesion was completely removed through the right optico-carotid space. Histological examination showed epithelioid cell granuloma with caseous necrosis, which strongly suggested mycobacterial infection. However, acid-fast staining detected no bacteria. Polymerase chain reaction (PCR) examinations of the gastric juice and cerebrospinal fluid for tuberculosis were negative. Nested PCR and deoxyribonucleic acid (DNA) sequencing of the DNA from the surgical specimen disclosed Mycobacterium tokaiense DNA sequences. This rare case of pituitary stalk granuloma caused by M. tokaiense shows that if the surgical specimen contains caseous necrosis, nested PCR and DNA sequencing are useful methods to identify mycobacterial infection.
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  • Acute Subdural Hematoma Originating From the Lacerated Intracranial Internal Carotid Arteries
    —Case Report—
    Hirofumi OYAMA, Shigekazu NAKAMURA, Masashi UEYAMA, Akira IKEDA, Takuy ...
    2006 Volume 46 Issue 2 Pages 84-87
    Published: 2006
    Released on J-STAGE: February 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.84
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    A 51-year-old male presented with laceration of the bilateral intracranial internal carotid arteries (ICAs) manifesting as acute subdural hematoma (SDH) after a fall of 3 m. Brain computed tomography showed acute SDH appearing as irregular mixed high and low density and causing midline shift. During the operation, massive liquiform hematoma flowed out from the deep portion around the cranial base and systemic blood pressure decreased abruptly. Hemostasis was impossible and he died soon after the operation. Autopsy revealed skull fractures in the bilateral sphenoidal, orbital, temporal, frontal, parietal, and occipital bones, and laceration of the bilateral ICAs in the cavernous sinuses at the fracture sites. Acute SDH can be caused by laceration of the ICA.
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  • Middle Cerebral Artery Occlusion Associated With Acute Myocardial Infarction in the Perioperative Period
    —Case Report—
    Tomomi IWASHITA, Kazuo KITAZAWA, Jun-Ichi KOYAMA, Hisashi NAGASHIMA, T ...
    2006 Volume 46 Issue 2 Pages 88-91
    Published: 2006
    Released on J-STAGE: February 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.88
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    A 68-year-old woman with no history of cardiac events suffered acute myocardial infarction after surgery for middle cerebral artery (MCA) occlusion manifesting as transient left motor weakness. Diffusion-weighted magnetic resonance imaging revealed multiple infarctions in the right cerebral hemisphere. Magnetic resonance angiography and cerebral angiography demonstrated an occlusion at the horizontal segment of the right MCA and no collateral circulation. Cerebral blood flow study 6 weeks after the initial presentation indicated decreased blood flow in the right cerebral hemisphere. Superficial temporal artery-MCA anastomosis was conducted to prevent recurrent cerebral infarction. Two hours after surgery, her systolic blood pressure fell to 60 mmHg and her consciousness worsened. Emergency coronary angiography indicated occlusion of the right coronary artery. Percutaneous coronary intervention was successfully performed and the subsequent course was uneventful. Preoperative evaluation of the coronary artery may be necessary before surgery for cerebral ischemic disease in both the intracranial and extracranial arteries.
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  • Meningeal Hemangiopericytoma Manifesting as Massive Intracranial Hemorrhage
    —Two Case Reports—
    Jun MARUYA, Yasuhiro SEKI, Kenichi MORITA, Keiichi NISHIMAKI, Takashi ...
    2006 Volume 46 Issue 2 Pages 92-97
    Published: 2006
    Released on J-STAGE: February 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.92
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    Meningeal hemangiopericytoma is rare, and only seven cases have manifested as intracranial hemorrhage. We treated two patients with meningeal hemangiopericytoma manifesting as life-threatening massive intracerebral hemorrhage. Case 1: A 66-year-old woman presented with consciousness disturbance and left hemiparesis. Computed tomography showed a mass lesion in the right frontal parasagittal region and massive hematoma in the brain tissue at the medial border of the lesion. Immediate evacuation of the hematoma was performed. Postoperative magnetic resonance imaging revealed a well-enhanced mass lesion with small intratumoral hemorrhage. The tumor was removed totally through a bilateral frontal craniotomy. The postoperative course was uneventful. The histological diagnosis was meningeal hemangiopericytoma. Radiotherapy was not performed. Case 2: A 59-year-old man presented with consciousness disturbance. Computed tomography showed a mass lesion in the right frontotemporal convexity region and massive hematoma in the brain tissue at the medial border of the lesion. His neurological condition was refractory to any treatment and the clinical diagnosis of brain death was confirmed. Autopsy was performed and the histological diagnosis was meningeal hemangiopericytoma. Meningeal hemangiopericytoma manifesting as intracranial hemorrhage is quite rare, but carries the risk of life-threatening massive bleeding from the tumor.
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  • Abducens Nerve Palsy in a Patient With a Parasagittal Meningioma
    —Case Report—
    Ibrahim M. ZIYAL, Gökhan BOZKURT, Burçak BILGINER, Salih G ...
    2006 Volume 46 Issue 2 Pages 98-100
    Published: 2006
    Released on J-STAGE: February 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.98
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    A 67-year-old female presented with isolated unilateral abducens nerve palsy progressing in 10 days. There were no signs of elevated intracranial pressure. Magnetic resonance imaging revealed a right parasagittal meningioma. The tumor was grossly totally removed and the patient’s nerve palsy gradually improved within 3 weeks. The mechanism of the isolated abducens nerve palsy in this case is attributed to compression of the abducens nerve by entrapment of the cerebrospinal fluid just before entering Dorello’s canal under the petrolingual ligament. Linear forces in the midsagittal plane due to the mass effect of the tumor may have temporarily increased the local cerebrospinal fluid pressure and caused ‘pseudoentrapment’ of the abducens nerve.
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  • Benign Pleomorphic Astrocytoma in the Hypothalamus
    —Case Report—
    Tatsuya ABE, Ryo INOUE, Mitsuo ISONO, Keisuke ISHII, Minoru FUJIKI, To ...
    2006 Volume 46 Issue 2 Pages 101-103
    Published: 2006
    Released on J-STAGE: February 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.101
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    A 41-year-old woman presented with an unusual case of benign astrocytoma with marked pleomorphism manifesting as consciousness disturbance due to intraventricular hemorrhage. Magnetic resonance imaging revealed a well-enhanced hypothalamic mass protruding into the third ventricle. Despite partial resection of the tumor without additional therapy, there have been no signs of tumor regrowth for 6 years. The histological findings revealed solid proliferation of tumor cells with marked pleomorphism, contrary to the benign clinical course. However, no mitosis, necrosis, or endothelial proliferation were found and the MIB-1 index was less than 0.5%. Immunohistochemical staining indicated the glial origin of the tumor. The tumor was similar to pleomorphic xanthoastrocytoma, but the histological findings were not exactly identical, indicating a new histological entity.
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Technical Note
  • New Technique for Decompressive Duraplasty Using Expanded Polytetrafluoroethylene Dura Substitute
    —Technical Note—
    Shigeru MIYAKE, Atsushi FUJITA, Hideo AIHARA, Eiji KOHMURA
    2006 Volume 46 Issue 2 Pages 104-106
    Published: 2006
    Released on J-STAGE: February 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.104
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    A new technique for decompressive craniectomy with duraplasty was developed for cases in which brain swelling was present at dural closure. Expanded polytetrafluoroethylene (ePTFE) membrane is placed under the dura, covering the brain surface, without the use of sutures. The dura is then loosely sutured. The procedure was used in 13 patients. No leakage of cerebrospinal fluid into the epidural space or signs of infection were observed. Sutureless insertion of an ePTFE membrane at external decompression may increase the ease of duraplasty, decrease operating time, and avoid injury to the brain resulting from suturing the dura. The technique might be especially useful in emergency cases.
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Letter to the Editor
Editorial Committee
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