Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 46, Issue 5
Displaying 1-13 of 13 articles from this issue
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Original Articles
  • Cardiopulmonary Hemodynamic Changes During Acute Subdural Hematoma Evacuation
    Tomonori TAMAKI, Yoji NODE, Yasuhiro YAMAMOTO, Akira TERAMOTO
    2006 Volume 46 Issue 5 Pages 219-225
    Published: 2006
    Released on J-STAGE: May 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.219
    JOURNAL OPEN ACCESS
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    The aim of this study was to clarify the mechanism of hemodynamic changes leading to intraoperative hypotension during evacuation of acute subdural hematoma. To our knowledge, little data is available about the mechanism of hemodynamic changes during surgical interventions to decrease intracranial pressure after severe head injury. The influence of preoperative hypotension on intraoperative hypotension was examined. Hemodynamic studies (pulmonary artery catheterization) were carried out in 15 patients before and after acute subdural hematoma evacuation. All patients were assessed for hemodynamic parameters, evacuated hematoma volume, and intracranial pressure measurements. Comparison between just before and after evacuation of the hematoma showed that the mean arterial pressure, pulmonary arterial pressure, systemic vascular resistance, pulmonary vascular resistance, central venous pressure, and pulmonary capillary wedge pressure all decreased after hematoma evacuation. However, the cardiac index was unchanged after hematoma evacuation. Mean arterial blood pressure is dependent on the cardiac index and vascular resistance, so the decrease in arterial blood pressure during hematoma evacuation was the result of a decline in vascular resistance. The influence of preoperative blood pressure on intraoperative hemodynamic changes was analyzed by dividing the patients into two groups, the preoperative hypotension group and preoperative nonhypotension group. The decrease in mean arterial blood pressure was more marked in the preoperative hypotension group than in the preoperative nonhypotension group. Intraoperative hypotension during evacuation of acute subdural hematoma is caused by a decrease in vascular resistance. Preoperative hypotension is a also risk factor for intraoperative hypotension.
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  • Analysis of Risk Factors for Infection in Coplacement of Percutaneous Endoscopic Gastrostomy and Ventriculoperitoneal Shunt
    Shinya NABIKA, Shuichi OKI, Masayuki SUMIDA, Naoyuki ISOBE, Yukari KAN ...
    2006 Volume 46 Issue 5 Pages 226-230
    Published: 2006
    Released on J-STAGE: May 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.226
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    Patients with severe neurological impairment requiring tube feeding may have concomitant hydrocephalus. Coplacement of percutaneous endoscopic gastrostomy (PEG) and ventriculoperitoneal (VP) shunting is currently standard in such cases. The present study investigated the risk factors for shunt infection in such patients. The medical records of 23 patients with PEG and VP shunting were retrospectively reviewed. Correlations between shunt system infection and potential risk factors were analyzed including order of PEG and VP shunting, position of abdominal shunt catheter, diabetes mellitus, tracheostomy, and activities of daily living. Twelve patients underwent VP shunting after PEG and 11 underwent PEG after VP shunt placement. Four patients experienced shunt infection, and three required shunt revision. Three of these four patients underwent VP shunting after PEG. The period between PEG and VP shunt placement was 18, 19, and 25 days, shorter than the mean period of 29.3 days. VP shunting can be combined with PEG, but a larger study is required to clearly identify the risk factors. Administration of prophylactic antibiotics and a period of at least 1 month between the procedures are recommended, particularly if the shunt is placed after the PEG tube.
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  • Predictors of Outcome of Surgery for Cervical Compressive Myelopathy: Retrospective Analysis and Prospective Study
    Young-Su PARK, Hiroyuki NAKASE, Shoichiro KAWAGUCHI, Toshisuke SAKAKI, ...
    2006 Volume 46 Issue 5 Pages 231-239
    Published: 2006
    Released on J-STAGE: May 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.231
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    The outcomes of surgical treatment in 80 patients with cervical compressive myelopathy were retrospectively reviewed to examined the correlations between surgical outcomes and the following seven predictive factors: age at surgery, duration of symptoms, severity of myelopathy, number of compressed segments, intramedullary high intensity segments on T2-weighted magnetic resonance (MR) imaging, surgical method, and the type of disease. The recovery rates were evaluated at 3 months after the surgery. Significant correlations were observed between recovery rate and duration of symptoms, severity of myelopathy, and high intensity segments on T2-weighted MR imaging. No statistical correlation was observed with the other factors. Multivariate analysis revealed significant correlations between recovery rate and duration of symptoms and number of high intensity segments on T2-weighted MR imaging. The multiple regression equation was expressed as follows: recovery rate = 82.981 + 0.101 × (age) - 0.675 × (duration) - 1.452 × (number of compressed segments) - 1.451 × (preoperative Neurosurgical Cervical Spine Scale) - 13.826 × (number of high intensity segments). Based on this predicted formula, we compared the predicted and actual recovery rates for 17 patients treated recently. The two values were similar except in two patients with long duration of symptoms. We conclude that the surgical outcome can be predicted to a certain extent and this information could be provided to patients considering surgery for cervical compressive myelopathy.
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Case Reports
  • Transient Occipitotemporal Subcortical Diffusion-Weighted Magnetic Resonance Imaging Abnormalities Associated With Status Epilepticus
    —Case Report—
    Adam TUCKER, Hiroji MIYAKE, Masao TSUJI, Tohru UKITA, Kentaro NISHIHAR ...
    2006 Volume 46 Issue 5 Pages 240-243
    Published: 2006
    Released on J-STAGE: May 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.240
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    A 30-year-old man presented with a generalized seizure manifesting as decreased consciousness. Diffusion-weighted magnetic resonance imaging showed transient areas of high intensity in the gray and subcortical white matter of the left occipital and temporal lobes. The lesions did not reflect the vascular territories. After a period of over 2 weeks, his consciousness level improved associated with reduced intensity of the abnormal areas. These findings suggest that seizure induced reversible cytotoxic and vasogenic edema. Transient diffusion-weighted magnetic resonance imaging abnormalities may be associated with generalized seizures and the intensity may reflect the clinical condition.
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  • Endovascular Treatment of Ruptured Aneurysms Associated With Fenestrated Basilar Artery
    —Two Case Reports—
    Yutaka KAI, Jun-ichiro HAMADA, Motohiro MORIOKA, Shigetoshi YANO, Shod ...
    2006 Volume 46 Issue 5 Pages 244-247
    Published: 2006
    Released on J-STAGE: May 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.244
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    Two patients with ruptured aneurysm associated with fenestrated basilar artery (BA) were treated using the endovascular approach. Angiography showed these patients had different types of BA bifurcation. One type had two points of bifurcation and a bridging artery in the BA fenestration, with the aneurysm at the bifurcation of the right loop of the fenestration. The aneurysm had different appearances on right and left vertebral angiograms. The other type had only one point of bifurcation, and the appearance of this aneurysm was similar on both angiograms. To ensure successful embolization, bilateral vertebral angiography should be performed for complete assessment of the morphological characteristics of aneurysm associated with fenestrated BA.
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  • Hyperperfusion Syndrome After Clipping of an Unruptured Aneurysm
    —Case Report—
    Kazuhiko KUROKI, Haruyoshi TAGUCHI, Osamu YUKAWA
    2006 Volume 46 Issue 5 Pages 248-250
    Published: 2006
    Released on J-STAGE: May 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.248
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    A 41-year-old man developed hyperperfusion 24 hours after undergoing successful clipping surgery for an unruptured middle cerebral artery aneurysm with temporary occlusion for 7 minutes. The patient exhibited motor aphasia 24 hours after surgery. Single photon emission computed tomography revealed hyperperfusion. The patient was sedated for 72 hours using propofol, and his symptoms gradually resolved. He returned to his previous job 2 months after surgery. Hyperperfusion syndrome is possible following any aneurysm surgery, including surgery for unruptured aneurysms using the temporary occlusion technique.
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  • Choroid Plexus Carcinoma Secreting Carbohydrate Antigen 19-9 in an Adult
    —Case Report—
    Hideo OSADA, Kentaro MORI, Takuji YAMAMOTO, Yasuaki NAKAO, Ryo WADA, M ...
    2006 Volume 46 Issue 5 Pages 251-253
    Published: 2006
    Released on J-STAGE: May 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.251
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    A 53-year-old man presented with a choroid plexus carcinoma in the body of the right lateral ventricle manifesting as gait disturbance due to left mild hemiparesis and papilledema. Subtotal removal of the tumor was performed. Histological examination revealed well-differentiated papillary adenocarcinoma. Immunohistochemical examination showed intense reactivity for carbohydrate antigen 19-9 (CA19-9). The serum level of CA19-9 was significantly high, but decreased rapidly after radiation therapy. Systemic examinations found no malignancy in other organs. This second case of choroid plexus carcinoma producing CA19-9 indicates that CA19-9 may be a useful marker of choroid plexus carcinoma.
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  • Perisacral Gastrointestinal Stromal Tumor With Intracranial Metastasis
    —Case Report—
    Shougo KAKU, Toshihide TANAKA, Toshihiro OHTUKA, Koujirou SEKI, Satosh ...
    2006 Volume 46 Issue 5 Pages 254-257
    Published: 2006
    Released on J-STAGE: May 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.254
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    A 68-year-old woman presented with an extremely rare intracranial metastasis from a gastrointestinal stromal tumor (GIST) manifesting as left hemiparesis 2 years after resection of a sacral tumor adjacent to the coccygeal bone. Magnetic resonance imaging revealed an intracranial tumor in the right parietal lobe. Craniotomy was performed to completely remove the tumor. Although the tumor was located extra-axially, only internal carotid angiography showed mass staining. Seven months after surgery, the tumor recurred. Repeat craniotomy was performed to remove the recurrent tumor. Immunohistochemical analysis showed that the tumor cells were positive for c-kit and CD34, and the tumors were identified as intracranial metastasis of GIST. Following the second intracranial surgery, the patient developed severe lower back pain caused by metastatic tumor invading the lumbar spine and ureter. To avoid surgical complications and to reduce tumor volume, imatinib mesylate (Gleevec®) was administered. The severe pain was relieved, although the tumor was not reduced. In this case, the extra-axial tumor was fed only by the internal carotid artery.
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  • Lumbosacral Subdural Hematoma
    —Case Report—
    Ryota MASHIKO, Shozo NOGUCHI, Kazuya UEMURA, Tomoya TAKADA, Akira MATS ...
    2006 Volume 46 Issue 5 Pages 258-261
    Published: 2006
    Released on J-STAGE: May 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.258
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    An 18-year-old man presented with a rare spinal subdural hematoma (SSH) manifesting as headache, which developed following diving into the sea the day before. Computed tomography of the head revealed no abnormality. His headache persisted followed by neck stiffness and mild lumbago. He came to see us 6 days after the first visit. He underwent lumbar puncture to eliminate the possibility of meningitis. The cerebrospinal fluid showed xanthochromia. Cerebral angiography showed no abnormality. Magnetic resonance imaging of the spine revealed lumbosacral subdural hematoma. The hematoma and his symptoms regressed spontaneously during several weeks of conservative treatment. A sharp increase in intraabdominal and/or intrathoracic pressures following diving may have caused the bleeding. Headache may be an initial symptom associated with subarachnoid hemorrhage concomitant with SSH. Delayed progression of lumbosacral SSH must be considered if the patient complains of lumbago following minor trauma.
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Technical Note
  • Continuous Suction Method in Superficial Temporal Artery-Middle Cerebral Artery Anastomosis Surgery
    —Technical Note—
    Jun-ichi KOYAMA, Yuichiro TANAKA, Tomomi IWASHITA, Kazuo KITAZAWA, Kaz ...
    2006 Volume 46 Issue 5 Pages 262-264
    Published: 2006
    Released on J-STAGE: May 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.262
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    A new method was developed to maintain a bloodless microscopic operative field for superficial temporal artery-middle cerebral artery (MCA) anastomosis surgery. A silicone suction tube with multiple holes is placed circumferentially under the reflected dural flaps around the craniotomy. Blood and irrigated saline are continuously aspirated by the tube. Use of this method in nine patients significantly reduced the mean MCA trapping time (24.0 ± 2.8 min) compared with nine patients treated using the conventional method (30.1 ± 4.6 min). MCA trapping time is shortened because the surgery is not interrupted for manual suctioning of bloody cerebrospinal fluid.
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Letter to the Editor
Editorial Committee
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