Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 46, Issue 7
Displaying 1-12 of 12 articles from this issue
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Original Articles
  • Effect of Therapeutic Moderate Hypothermia on Multi-drug Resistance Protein 1-Mediated Transepithelial Transport of Drugs
    Jiang-shu JIN, Toshiyuki SAKAEDA, Mikio KAKUMOTO, Kohshi NISHIGUCHI, T ...
    2006 Volume 46 Issue 7 Pages 321-327
    Published: 2006
    Released on J-STAGE: July 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.321
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    To clarify the effect of therapeutic moderate hypothermia on drug distribution, transepithelial transport via multi-drug resistance protein 1 (MDR1) (also called P-glycoprotein or ABCB1) was evaluated at various temperatures in vitro using LLC-GA5-COL150 cells, which were established by transfecting human MDR1 complementary deoxyribonucleic acid into kidney epithelial LLC-PK1 cells and express MDR1 on the apical membrane. MDR1 is expressed in the blood-brain barrier to limit drug distribution to the brain by exporting exogenous substances including calcium blockers and antiarrhythmic drugs. Digoxin was used as a typical substrate, as well as the non-substrate tetracycline and paracellular marker inulin. MDR1-mediated transport of digoxin decreased at lower temperatures. Transport of tetracycline also decreased at lower temperatures, probably due to changes in membrane fluidity. However, no change was found at over 32°C, suggesting that passive diffusion does not change during moderate hypothermia. The distribution of MDR1 substrates should be considered during hypothermic conditions, as the clinical outcome could be affected.
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  • Sex-Related Differences in Patients Treated Surgically for Aneurysmal Subarachnoid Hemorrhage
    Tetsuyoshi HORIUCHI, Yuichiro TANAKA, Kazuhiro HONGO
    2006 Volume 46 Issue 7 Pages 328-332
    Published: 2006
    Released on J-STAGE: July 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.328
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    Sex-related differences were examined in the clinical course of patients treated surgically for aneurysmal subarachnoid hemorrhage. Retrospective analyses were carried out to evaluate sex-related differences in aneurysm location, aneurysm size, preoperative neurological condition, preoperative computed tomography findings, and outcome among 2577 patients who underwent surgical repair of ruptured aneurysms. The internal carotid artery was most frequently affected in women and the anterior cerebral artery in men. Intracerebral or intraventricular hematoma was more common in men than in women. Some differences may be related to the location of the aneurysm. Sex-related differences were prominent in the 5th decade of life. These findings might be related to the menopause. Sex hormones may be involved in aneurysm formation.
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  • Various Magnetic Resonance Imaging Patterns of Chronic Subdural Hematomas: Indicators of the Pathogenesis?
    Hirosuke FUJISAWA, Sadahiro NOMURA, Koji KAJIWARA, Shoichi KATO, Masam ...
    2006 Volume 46 Issue 7 Pages 333-339
    Published: 2006
    Released on J-STAGE: July 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.333
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    Magnetic resonance (MR) imaging can detect various patterns in chronic subdural hematomas. These patterns were compared to the computed tomography (CT) appearances and chemical analysis of the content in 60 hematomas from 44 patients. The hematomas could be classified into five types on both T1- and T2-weighted images: low, high, and mixed intensity, isointensity, and layered. Combining the T1- and T2-weighted images of all 60 hematomas revealed a total of 14 different imaging patterns. Combining the CT and MR imaging findings of 55 hematomas identified 25 different patterns. Analysis of the hematoma contents showed that hemolysis-related parameters, such as potassium, glutamate oxaloacetate transaminase, bilirubin, lactate dehydrogenase, and protein concentration, were markedly higher than in the peripheral blood, and there were significant correlations between these parameters. Mixed intensity hematomas were significantly thicker than the other types, and showed markedly higher values of hemolysis-related parameters. Factors affecting the CT and MR imaging findings, such as fresh bleeding, hemolysis, and hemoglobin changes, coexist in a hematoma to varying degrees, and these factors may interact with the age of the hematoma to produce the different patterns that are observed.
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Case Reports
  • Trapping and Vascular Reconstruction for Ruptured Fusiform Aneurysm in the Proximal A1 Segment of the Anterior Cerebral Artery
    —Case Report—
    Hiroshi KASHIMURA, Tomohiko MASE, Kuniaki OGASAWARA, Akira OGAWA, Hide ...
    2006 Volume 46 Issue 7 Pages 340-343
    Published: 2006
    Released on J-STAGE: July 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.340
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    A 65-year-old woman presented with subarachnoid hemorrhage (SAH). Angiography detected a small bulge in the A1 segment of the right anterior cerebral artery (ACA). The patient was managed conservatively. Ten days after the initial SAH, the patient suffered a second SAH. Cerebral angiography demonstrated a fusiform aneurysm in the right A1 segment and vasospasm in the left A1 segment. The aneurysm of the right A1 segment was trapped and the right superficial temporal artery (STA) was end-to-end anastomosed to the distal portion of the right A1 segment. The patient had no postoperative cerebral ischemic events. Postoperative cerebral angiography revealed that the bypass flow through the right STA perfused the right ACA territories. STA-A1 end-to-end anastomosis can prevent cerebral ischemic events following parent vessel occlusion or microsurgical trapping for fusiform cerebral aneurysms in the A1 segment without sufficient collateral flow to the ipsilateral ACA territory from the contralateral ACA.
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  • Terson’s Syndrome as the Initial Symptom of Subarachnoid Hemorrhage Caused by Ruptured Vertebral Artery Aneurysm
    —Case Report—
    Tomohiro INOUE, Kazuo TSUTSUMI, Takashi SHIGEEDA
    2006 Volume 46 Issue 7 Pages 344-347
    Published: 2006
    Released on J-STAGE: July 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.344
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    A 61-year-old male initially presented to the ophthalmology department complaining of sudden visual loss. Fundus photography and ultrasonography followed by computed tomography identified Terson’s syndrome caused by subarachnoid hemorrhage (SAH). Cerebral angiography revealed a dissecting aneurysm of the left vertebral artery. Other than obtunded visual acuity, his neurological examination was normal and he denied any headache. He was treated conservatively with pain and blood pressure control. He complained of headache associated with rerupture of the aneurysm on day 5. The patient died of rerupture on day 14. The clinical course of this patient indicates that Terson’s syndrome may occur without sudden increase of intracranial pressure. Terson’s syndrome may occur as a rare initial clinical sign of SAH caused by ruptured cerebral aneurysm.
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  • Aneurysmal Subarachnoid Hemorrhage in a Patient With Human Immunodeficiency Virus Type 1 Infection
    —Case Report—
    Shinya MIYAMOTO, Tetsuo HARA, Yusuke TABEI, Hideki HONMA, Tatsuya KOND ...
    2006 Volume 46 Issue 7 Pages 348-352
    Published: 2006
    Released on J-STAGE: July 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.348
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    A 54-year-old human immunodeficiency virus type 1 (HIV-1)-infected homosexual Japanese male was found to have collapsed in his bathroom and was brought to our facility with diminished level of consciousness. Computed tomography showed subarachnoid hemorrhage (SAH). He was severely dehydrated with unstable general status that deterred us from performing emergent surgery. Cerebral angiography performed on the 18th hospital day revealed bilateral distal anterior cerebral artery aneurysms. Clipping of these aneurysms was performed on the 30th hospital day and no postoperative complications were experienced. The scalp wound showed no delayed healing, whereas the tracheostomy wound showed repeated wound dehiscence and delayed healing. Postoperative highly active antiretroviral therapy with antibiotic treatment gradually improved his general and immunological conditions. The patient was finally discharged as independent with mild muscle weakness in the bilateral lower extremities. HIV-1 infection should not be the guiding factor in the decision to aggressively treat concomitant aneurysmal disease. Clipping of cerebral aneurysms with full craniotomy or endovascular obliteration should be considered even in HIV-1-infected patients with SAH.
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  • Monofocal Acute Inflammatory Demyelination Manifesting as Open Ring Sign
    —Case Report—
    Jiro AKIMOTO, Nobuyuki NAKAJIMA, Akihiko SAIDA, Jo HARAOKA, Motoshige ...
    2006 Volume 46 Issue 7 Pages 353-357
    Published: 2006
    Released on J-STAGE: July 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.353
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    A 48-year-old woman with a history of viral influenza infection was admitted with rapidly progressive numbness and weakness of the right extremities. On admission, general physical examination revealed no abnormality. Cerebrospinal fluid analysis showed no abnormal findings. Brain computed tomography and magnetic resonance imaging showed an open ring-like enhanced lesion in the white matter of the right parietal lobe with massive perifocal edema. Cerebral angiography showed no tumor staining and thallium-201 single photon emission computed tomography showed no abnormal uptake. The preoperative diagnosis was malignant glioma and partial resection was performed. Histological examination showed perivascular accumulation of small lymphocytes and a large number of macrophages with reactive astrocytes. Phagocytosis of myelin was observed in the macrophages and nuclear fragmentation in the reactive astrocytes. The histological diagnosis was acute inflammatory demyelinating disease. After therapy with methylprednisolone, her neurological symptoms improved gradually and no relapse occurred during 18 months of follow up. Tumor-like masses of demyelination may occupy an intermediate position between acute multiple sclerosis and postinfectious encephalitis. Open ring sign may be a pathognomonic feature of these lesions.
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  • Adenoid Cystic Carcinoma of the Cavernous Region
    —Case Report—
    Kazuhide ADACHI, Kazunari YOSHIDA, Ryo UEDA, Takeshi KAWASE
    2006 Volume 46 Issue 7 Pages 358-360
    Published: 2006
    Released on J-STAGE: July 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.358
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    A 62-year-old Japanese male patient presented with right oculomotor, abducens, and trigeminal nerve disturbances. Neuroimaging revealed a right middle cranial fossa mass lesion with the characteristics of trigeminal schwannoma. The patient underwent a right temporal craniotomy for gross total resection. Histological examination confirmed a metastasis of adenoid cystic carcinoma (ACC). After the operation, no evidence of the primary lesion could be found. The patient was treated with radiation therapy. ACC can be difficult to identify before histological confirmation. The incidence of intracranial invasion of ACC is 4-22%, but in this case no evidence of the primary lesion was found.
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  • Huge Arachnoid Cyst of the Occipital Cerebral Convexity
    —Case Report—
    Adam TUCKER, Hiroji MIYAKE, Takehisa OMURA, Masao TSUJI, Tohru UKITA, ...
    2006 Volume 46 Issue 7 Pages 361-365
    Published: 2006
    Released on J-STAGE: July 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.361
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    A 68-year-old woman presented with a rare huge right occipital cystic lesion manifesting as progressive left hemiplegia. Cranial computed tomography revealed a 4 × 7 cm right occipital lobe thin-walled cyst with midline shift and compression of the ipsilateral ventricle. The patient underwent a single burr hole operation for cystography and delineation of the cyst anatomy, then a separate right parieto-occipital craniotomy with complete cyst evacuation, corticotomy, and ventriculostomy. The presumptive diagnosis was arachnoid cyst. The symptoms had completely resolved by 4 months after surgery with nearly normal neuroimaging appearance after 7 months. Cystography followed by craniotomy and ventriculostomy may be effective for supratentorial arachnoid cysts.
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  • Cervical Spondylotic Amyotrophy Treated by Anterior Decompression
    —Three Case Reports—
    Kentaro MORI, Takuji YAMAMOTO, Yasuaki NAKAO, Minoru MAEDA
    2006 Volume 46 Issue 7 Pages 366-370
    Published: 2006
    Released on J-STAGE: July 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.366
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    Cervical spondylotic amyotrophy (CSA) is a rare type of cervical spondylotic disorder. The surgical treatment of CSA is controversial. We treated three patients with the proximal type of CSA by anterior decompression. Three men (65, 61, and 58 years old) presented with CSA manifesting as unilateral muscle weakness and atrophy in the deltoid and biceps muscles without significant sensory deficit. Preoperative neuroradiological examinations revealed anterolateral spinal cord compression in one patient and ventral root compression in two patients at the C4-5 and C5-6 spaces. Magnetic resonance (MR) imaging showed no abnormal intramedullary signal intensity in any patient. Vertebrotomy deviated to the lesion side was performed to provide a better view of the laterally situated osteophytes. Anterior decompression was focused on the paramedial to lateral area, and further foraminotomy was performed according to the radiological findings. After decompression, intervertebral instrumentation was performed using titanium cervical cages. Two of the patients had good recovery of motor strength and one had moderate recovery despite persistent motor atrophy. Surgical intervention is effective in patients with CSA despite severe muscle atrophy unless MR imaging shows the presence of severe degenerative intramedullary lesion.
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Erratum
  • Erratum
    Article type: Errata
    2006 Volume 46 Issue 7 Pages 372
    Published: 2006
    Released on J-STAGE: July 24, 2006
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    To the Readership: The first author's name was incorrectly reported in the Commentary of the above-mentioned article. Wrong:Dr. Fujimoto and coauthors have pointed out an important problem for...
    Right:Dr. Yoshimoto and coauthors have pointed out an important problem for...
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Editorial Committee
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