Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 46, Issue 8
Displaying 1-12 of 12 articles from this issue
Original Articles
  • Keisuke IMAI, Takahisa MORI, Hajime IZUMOTO, Nozomu TAKABATAKE, Takeno ...
    2006 Volume 46 Issue 8 Pages 373-378
    Published: 2006
    Released on J-STAGE: August 25, 2006
    JOURNAL OPEN ACCESS
    The efficacy of hyperbaric oxygen (HBO) therapy combined with intravenous edaravone (free radical scavenger) administration was prospectively investigated in patients with acute embolic stroke involving the anterior cerebral circulation. Patients with acute embolic stroke in the anterior cerebral circulation admitted within 48 hours of onset from August 2001 to March 2002 with National Institutes of Health Stroke Scale (NIHSS) scores on admission of 5 or more were assigned randomly to HBO and control groups. The HBO group underwent HBO therapy combined with intravenous edaravone administration for 7 days, whereas the control group received only conventional treatment. The primary endpoint was the modified Rankin Scale score at 90 days (favorable outcome, score 0 or 1). The secondary endpoint was the NIHSS score at 7 days. Analysis was carried out by intention to treat. Six of the 19 patients in the HBO group, but only one of the 19 patients in the control group, had favorable outcomes at 90 days (p < 0.05), although NIHSS score at 7 days did not differ significantly between the two groups. HBO therapy combined with intravenous edaravone administration appears to be effective for the treatment of patients with acute embolic stroke in the anterior cerebral circulation.
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  • Hiroyuki NAKASE, Yasushi SHIN, Yukihide KANEMOTO, Hideyuki OHNISHI, Te ...
    2006 Volume 46 Issue 8 Pages 379-386
    Published: 2006
    Released on J-STAGE: August 25, 2006
    JOURNAL OPEN ACCESS
    The long-term outcome of 39 patients with unruptured giant aneurysm (>2.5 cm) treated during the last 12 years was retrospectively reviewed. The 7 male and 32 female patients, aged 32 to 81 years, presented with symptoms related to compression of the surrounding structures by the aneurysm in 28 cases, cerebral infarction in one, and asymptomatic in 10. The locations were the internal carotid artery (ICA) in 27 cases, middle cerebral artery in three, anterior cerebral artery in one, and basilar artery in eight. Therapeutic modalities were direct clipping in 11 patients, ICA occlusion combined with extracranial-intracranial bypass in 15, and conservative treatment in 13. The follow-up period ranged from 16 to 128 months (mean 54.0 months). The mortality was 9% (1/11), 0% (0/15), and 31% (4/13), and morbidity was 18% (2/11), 20% (3/15), and 8% (1/13), respectively. Surgery reduced the mortality (from 31% to 4%) but increased the morbidity (from 8% to 19%) as compared with conservatively treated patients (p < 0.05). Giant intracranial aneurysm has a poor prognosis if left untreated, but these lesions are difficult to treat with the present management options.
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  • Takao WATANABE, Yoichi KATAYAMA, Akiyoshi OGINO, Takashi OHTA, Atsuo Y ...
    2006 Volume 46 Issue 8 Pages 387-394
    Published: 2006
    Released on J-STAGE: August 25, 2006
    JOURNAL OPEN ACCESS
    O6-methylguanine-deoxyribonucleic acid methyltransferase gene (MGMT) methylation is apparently correlated with responsiveness to nitrosourea chemotherapy, suggesting this alkylating agent should be effective against MGMT-methylated tumors. MGMT appears not to be linked to platinum resistance, so platinum chemotherapy should be used for MGMT-unmethylated tumors. This study was a preliminary trial of individualized chemotherapy based on MGMT methylation status in a total of 20 patients with newly diagnosed malignant astrocytomas (9 anaplastic astrocytomas and 11 glioblastomas multiforme). The procarbazine, 1-(4-amino-2-methyl-5-pyrimidinyl)methyl-3-2(2-chloroethyl)-3-nitrosourea, and vincristine (PAV) regimen was administered to seven patients with MGMT-methylated tumors, and the carboplatin and etoposide (CE) regimen was administered to 13 patients with MGMT-unmethylated tumors. Objective response to the PAV therapy was noted in all three patients with measurable residual tumor (2 complete responses and 1 partial response). Five of the seven patients continued to be disease-free after initiation of the PAV therapy. Objective response to the CE therapy was seen in only one of seven patients with measurable residual tumor (1 partial response). Three of the 13 patients were free from progression, whereas the remaining 10 patients showed early progression. The PAV regimen is effective against MGMT-methylated malignant astrocytomas, but the CE regimen is not useful at the given dose and schedule in MGMT-unmethylated tumors.
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Case Reports
  • —Case Report—
    Yasuhiko AKIYAMA, Masahito TANAKA, Junya HAYASHI, Motoaki FUJIMOTO, Ke ...
    2006 Volume 46 Issue 8 Pages 395-397
    Published: 2006
    Released on J-STAGE: August 25, 2006
    JOURNAL OPEN ACCESS
    A 59-year-old man presented with acute onset of visual loss in his right eye. He was treated under a diagnosis of retinal artery thrombosis. Ultrasonography revealed obstruction of the ipsilateral internal carotid artery (ICA). He had no risk factor for stroke and he denied any history of trauma. Follow-up ultrasonography obtained 6 months later showed spontaneous ICA recanalization. Cerebral angiography demonstrated an arterial wall flap suggesting ICA dissection at the craniocervical junction. He then remembered suffering hemicranial headache and Horner’s sign of several days’ duration after jumping off a stepladder 1 year earlier. The present case is quite unusual in that persistent carotid arterial wall dissection was thought to proceed to ICA obstruction and manifested as retinal ischemia after a long asymptomatic period.
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  • —Case Report—
    Yoshimasa MORI, Toshiki KONDO, Takayasu IWAKOSHI, Yoshihisa KIDA, Tats ...
    2006 Volume 46 Issue 8 Pages 398-400
    Published: 2006
    Released on J-STAGE: August 25, 2006
    JOURNAL OPEN ACCESS
    A 70-year-old woman with an asymptomatic parasagittal meningioma had been under observation with follow-up imaging for 2 years. She gradually developed motor weakness in the left hand. Magnetic resonance (MR) imaging disclosed a newly developed well-enhanced area in the cerebral parenchyma adjacent to the stable original meningioma. The new lesion was enhanced more intensely and less well demarcated. We suspected that the meningioma had enlarged into the brain parenchyma, although MR imaging suggested a border between the extra-axial and intra-axial portions. Craniotomy was performed. Two separate tumors were identified with quite different histological features. The extra-axial tumor was identified as benign transitional meningioma and the intra-axial tumor as diffuse large cell type malignant lymphoma. Immunostaining revealed the lymphoma had B cell origin. After surgical resection, stereotactic radiosurgery was performed for the residual lymphoma. The original site of the lymphoma remained free from relapse, but another lesion developed in the right frontal lobe 3 months later and chemotherapy was performed. The main concern for follow-up imaging of asymptomatic meningioma without surgical resection is growth of the meningioma. However, development of new different tumors is possible, although thought to be rare.
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  • —Case Report—
    Takafumi TANEI, Kazuhiro FUKUI, Takenori KATO, Kenichi WAKABAYASHI, No ...
    2006 Volume 46 Issue 8 Pages 401-404
    Published: 2006
    Released on J-STAGE: August 25, 2006
    JOURNAL OPEN ACCESS
    A 60-year-old man presented with a left frontal mass lesion incidentally detected at a health check without apparent symptoms. Computed tomography revealed the lesion as homogeneous high density and magnetic resonance (MR) imaging showed the lesion as hyperintense on T1-weighted images, isointense on T2-weighted images, and hypointense on diffusion-weighted images. T1-weighted MR images with gadolinium showed no enhancement of the mass lesion. Cerebral angiography revealed an avascular area around the left frontal lesion. Total removal of the lesion was achieved through a craniotomy without complications. Histological, immunohistochemical, and electron microscopy examinations established the definite diagnosis of colloid cyst.
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  • —Case Report—
    Satoshi UTSUKI, Satoru SHIMIZU, Hidehiro OKA, Sachio SUZUKI, Kiyotaka ...
    2006 Volume 46 Issue 8 Pages 405-407
    Published: 2006
    Released on J-STAGE: August 25, 2006
    JOURNAL OPEN ACCESS
    A 7-year-old girl presented in semicomatose condition. She had received a ventriculoperitoneal shunt using a Codman-Hakim programmable valve. Head computed tomography demonstrated hydrocephalus and head radiography showed that the pressure setting of the shunt valve had changed to 60 mmH2O from 40 mmH2O. The pressure setting was returned to 40 mmH2O, and she was discharged because her clinical symptoms and hydrocephalus improved. One month later, she lost consciousness again and was transported to our hospital. Hydrocephalus and shunt valve pressure of 50 mmH2O were noted, and the pressure setting was returned to 40 mmH2O again. She was discharged without complications. We suspected that the valve pressure was caused by close contact with a television, because the patient tended to touch a television with her head during play. The valve pressure did not change after the television was placed on a high stand out of reach. We should recognize that there are many sources of weak magnetic fields that may influence a programmable valve in everyday life.
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  • —Two Case Reports—
    Satoshi TOMURA, Kentaro MORI, Hideo OSADA, Yasuaki NAKAO, Takuji YAMAM ...
    2006 Volume 46 Issue 8 Pages 408-411
    Published: 2006
    Released on J-STAGE: August 25, 2006
    JOURNAL OPEN ACCESS
    A previously healthy 34-year-old woman and a previously healthy 35-year-old woman with spontaneous intracranial hypotension (SIH) presented within 1 week of the onset of symptoms. Brain magnetic resonance (MR) imaging with gadolinium demonstrated no abnormality, whereas spinal MR imaging revealed extradural fluid collection in both patients. Both patients were treated conservatively with bed rest and intravenous hydration. Their symptoms almost completely resolved. We suggest that spinal MR imaging findings of extradural fluid collection can help to establish the early diagnosis of SIH.
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  • —Case Report—
    Jong-Hyun KIM, Sang-Il SUH, Joo-Han KIM, Taek-Hyun KWON, Hung-Seob CHU ...
    2006 Volume 46 Issue 8 Pages 412-414
    Published: 2006
    Released on J-STAGE: August 25, 2006
    JOURNAL OPEN ACCESS
    A 67-year-old man presented with dizziness, nausea, and ataxia. Magnetic resonance imaging showed a large (5.5 × 4 × 4 cm) cystic lesion in the left cerebellar hemisphere with internal septation, a mural nodule, and thin rim enhancement. Cystic cerebellar tumor such as hemangioblastoma was initially suspected. Following surgery, the cyst was identified as cerebellar neurocysticercosis. Neurocysticercosis is the most common parasitic disease of the central nervous system but is occasionally misdiagnosed as tumor because of the varying neuroimaging presentation. This case shows that neurocysticercosis should be considered in the differential diagnosis of giant cystic lesions in the cerebellum as surgical intervention may be unnecessary.
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  • —Case Report—
    Nebi YILMAZ, Nejmi KIYMAZ, Omer ETLIK, Taner YAZICI
    2006 Volume 46 Issue 8 Pages 415-417
    Published: 2006
    Released on J-STAGE: August 25, 2006
    JOURNAL OPEN ACCESS
    A 26-year-old woman in the 28th week of pregnancy presented with a primary cerebral hydatid cyst manifesting as deteriorating consciousness and weakness in the left arm and leg. Cranial computed tomography revealed an intracranial hydatid cyst. The cyst was surgically removed and albendazole was administered. The patient had a spontaneous vaginal term delivery and no problem was observed in the mother or child. No primary focus was found in the lungs, liver, and other organs. Hydatid cyst is still an important disease. Intracranial hydatid cyst without primary foci in organs such as the liver and lungs is very rare. Primary cerebral hydatid cyst during pregnancy can be successfully treated by surgical and medical intervention.
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  • Lawrence H. PITTS
    2006 Volume 46 Issue 8 Pages 418
    Published: 2006
    Released on J-STAGE: August 25, 2006
    JOURNAL OPEN ACCESS
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