Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 47, Issue 9
Displaying 1-11 of 11 articles from this issue
Original Articles
  • Hiroyuki YOKOTA, Takahiro ATSUMI, Takashi ARAKI, Akira FUSE, Hidetaka ...
    2007 Volume 47 Issue 9 Pages 383-388
    Published: 2007
    Released on J-STAGE: September 25, 2007
    JOURNAL OPEN ACCESS
    Elevated serum levels of thrombomodulin (TM) and von Willebrand factor (vWf) are good indicators of injury and activation of cerebral endothelium in patients with severe simple head injury. The present study evaluated cerebral endothelial injury or activation as the serum levels of TM and vWf in elderly and younger patients with similar brain trauma, to evaluate the primary parenchymal injury of the brain. Patients with head injury were classified into the young group (16-30 years), the middle-aged group (31-65 years), and the elderly group (over 66 years). There was no difference in Glasgow Coma Scale on admission between the three groups. The serum levels of TM and vWf at 2 hours after injury were significantly higher in the elderly group than in the other groups. However, the serum levels of TM and vWf were not significantly different at 3 and 7 days after injury. Cerebral endothelial activation and injury were significantly higher in elderly patients just after head injury than in younger patients, which suggests that greater sensitivity to endothelial injury and activation may be important in the worse outcome after head injury in elderly patients compared with younger patients.
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  • Boris KRISCHEK, Hidetoshi KASUYA, Hideaki ONDA, Tomokatsu HORI
    2007 Volume 47 Issue 9 Pages 389-396
    Published: 2007
    Released on J-STAGE: September 25, 2007
    JOURNAL OPEN ACCESS
    Vasospasm following subarachnoid hemorrhage (SAH) remains difficult to prevent despite extensive investigative efforts. Nicardipine prolonged-release implants (NPRIs) have been used to prevent vasospasm in patients with SAH since October 1999. The present study analyzed the efficacy and safety of NPRIs in 100 patients with SAH and thick subarachnoid clot (mainly Fisher group 3) treated with NPRIs (diameter 2 mm, length 10 mm, containing 4 mg of nicardipine) during surgery after clipping of the aneurysm. The number and location of pellets depended on the amount and site of the subarachnoid clot on preoperative computed tomography and on the type of craniotomy. Two to 12 pellets were implanted in the cisterns of the internal carotid artery, middle cerebral artery, and/or anterior cerebral artery, where thick clots were present and vasospasm related to delayed ischemic neurological deficit (DIND) was highly likely. Only seven patients developed DIND and five patients suffered cerebral infarction. Angiography performed on days 7-12 revealed no vasospasm in any of the arteries close to the site of NPRI placement. NPRI placement can completely prevent vasospasm in arteries within the cisterns containing thick clots, but is less effective in remote locations.
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  • Shuyuan YANG, Chuan ZHANG, Tao ZHU, Li CAI, Shuo GAO, Shuyuan YUE, Wei ...
    2007 Volume 47 Issue 9 Pages 397-402
    Published: 2007
    Released on J-STAGE: September 25, 2007
    JOURNAL OPEN ACCESS
    Two patients presented with provisional diagnoses of glioma. Computed tomography (CT) and magnetic resonance imaging failed to show the boundaries of the tumor clearly. Positron emission tomography (PET)/CT with [18F]fluorodeoxyglucose and 11C-methionine clearly showed the location, extent, and heterogeneity of the tumors. The tumors were resected under PET/CT neuronavigation guidance. Histological examination of the specimens showed that PET/CT neuronavigation provided reliable distinction between normal brain and glioma, and that the uptake of PET tracers can indicate the degree of proliferation.
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  • Akira TSUNODA, Chikashi MARUKI
    2007 Volume 47 Issue 9 Pages 403-408
    Published: 2007
    Released on J-STAGE: September 25, 2007
    JOURNAL OPEN ACCESS
    The dual switch valve (DSV), which switches between two parallel valve chambers depending on the patient posture, was evaluated in 101 consecutive adult patients with hydrocephalus who required shunt surgery. The opening pressure was 5 or 10 cmH2O for the supine position and 30 or 40 cmH2O for the upright position depending on the sitting height. The results clearly showed that the DSV can regulate the intraventricular pressure (IVP) to 5 to 10 cmH2O in the supine and almost zero in the upright position, independently of posture. Ninety-four of the 101 patients received the DSV and 86 patients showed some clinical improvement. However, three patients required irrigation of subdural hematoma and six were thought to suffer underdrainage (4 probable and 2 possible). Such underdrainage probably resulted from the relatively high opening pressure in the supine position of 10 cmH2O and the bedridden state of these patients. This problem may be solved by the DSV with the 5 cmH2O setting in the supine position. The DSV can maintain physiological IVP in hydrocephalic patients independently of posture and provides generally satisfactory clinical outcome, but cannot prevent all inadequate drainage-related problems.
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Case Reports
  • —Two Case Reports—
    Takamitsu YAMAMOTO, Yoichi KATAYAMA, Toshiki OBUCHI, Toshikazu KANO, K ...
    2007 Volume 47 Issue 9 Pages 409-414
    Published: 2007
    Released on J-STAGE: September 25, 2007
    JOURNAL OPEN ACCESS
    The corticospinal motor evoked potential (MEP) evoked by motor cortex stimulation was investigated as an intraoperative index for the placement of stimulation electrodes in the epidural space over the motor cortex for the treatment of post-stroke pain. A grid of plate electrodes was placed in the epidural space to cover the motor cortex, sensory cortex, and premotor cortex employing a magnetic resonance imaging-guided neuronavigation system in two patients with severe post-stroke pain in the right extremities, a 66-year-old man with dysesthesia manifesting as burning and aching sensation, and a 67-year-old woman with dysesthesia manifesting as pricking sensation. The D-wave of the corticospinal MEP was recorded with a flexible wire electrode placed in the epidural space of the spinal cord during anodal monopolar stimulation of each plate electrode under general anesthesia. The grid electrode was fixed in position with dural sutures and the craniotomy closed. The effect of pain reduction induced by anodal monopolar stimulation of the same plate electrodes was examined using the visual analogue scale (VAS) on a separate day in the awake state without anesthesia. Comparison of the percentage VAS reduction and the recorded amplitude of the D-wave employing the same stimulation electrode revealed significant correlations in Case 1 (r = 0.828, p < 0.01) and Case 2 (r = 0.807, p < 0.01). The grid electrode was then replaced with two RESUME electrodes over the hand and foot areas, and the optimum positions were identified by D-wave recording before electrode fixation. Both patients reported satisfactory pain alleviation with lower stimulation voltages than usually required for patients with similar symptoms. These results indicate the potential of D-wave recording as an intraoperative indicator for the placement of stimulating electrodes over the motor cortex for pain relief.
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  • —Case Report—
    Salih GULSEN, Erkin SÖNMEZ, Fatih AYDEMIR, Hakan CANER, Nur ALTIN ...
    2007 Volume 47 Issue 9 Pages 415-418
    Published: 2007
    Released on J-STAGE: September 25, 2007
    JOURNAL OPEN ACCESS
    A 26-year-old construction worker presented with a nail settled in the C-7 corpus. He had no neurological or physical abnormalities. Preoperative evaluation of the vascular, neural, and aerodigestive structures with cervical radiography, computed tomography (CT), CT angiography, and contrast esophagography found no damage. The nail was completely exposed surgically and removed. The patient recovered with no deficits. Penetrating neck injury may be associated with significant morbidity and mortality due to vascular, neural, and aerodigestive tract injury. Patients in stable clinical condition should be evaluated by CT angiography, esophagography, and chest and cervical radiography.
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  • —Case Report—
    Myoung Soo KIM, Jong Joo RHEE, Seung Jun LEE, Seon-Joo KWON, Chae Heuc ...
    2007 Volume 47 Issue 9 Pages 419-423
    Published: 2007
    Released on J-STAGE: September 25, 2007
    JOURNAL OPEN ACCESS
    An 11-year-old girl with obstructive hydrocephalus developed akinetic mutism after treatment for hydrocephalus due to aqueductal stenosis by ventriculoperitoneal (VP) shunting. Bilateral chronic subdural hematomas developed about 2 months after insertion of the VP shunt and were evacuated. Postoperatively, the patient developed akinetic mutism, but her condition improved after administration of bromocriptine. Absence of abnormalities on dopamine transporter single photon emission computed tomography, lack of clinical response to levodopa treatment, and normal homovanillic acid concentration in the cerebrospinal fluid all indicated normal dopamine production. Pressure on the periventricular monoamine projections in the thalamus and hypothalamus without major dopamine deprivation in the striatum may have been the most important factors in the development of akinetic mutism in this patient.
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  • —Two Case Reports—
    Tae-Young JUNG, Shin JUNG
    2007 Volume 47 Issue 9 Pages 424-427
    Published: 2007
    Released on J-STAGE: September 25, 2007
    JOURNAL OPEN ACCESS
    A 54-year-old man and a 63-year-old woman presented with glioblastoma manifesting as seizure and headache, respectively. Magnetic resonance imaging of the two patients revealed hypointense area on T1-weighted imaging, and hyperintense area on T2-weighted and diffusion-weighted imaging, with no enhancement after gadolinium administration. Both patients underwent conservative therapy under diagnoses of non-neoplastic cerebral lesion. Six months later, they suffered aggravated symptoms and new neurological deficits. Follow-up magnetic resonance imaging revealed hypointense area on diffusion-weighted imaging and ring enhancement on T1-weighted imaging with gadolinium at the site of the previously detected lesions. The tumors showed growth pattern of superficial origin. The large enhanced masses were totally removed through craniotomy under neuronavigator guidance. The histological diagnoses were glioblastoma. Glioblastoma may mimic non-neoplastic conditions on neuroimaging in the early stages. Close follow up of such patients is essential.
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  • —Case Report—
    Masato MATSUMOTO, Kazuomi HORIUCHI, Taku SATO, Masahiro OINUMA, Jun SA ...
    2007 Volume 47 Issue 9 Pages 428-433
    Published: 2007
    Released on J-STAGE: September 25, 2007
    JOURNAL OPEN ACCESS
    An 8-year-old boy presented with a rare cerebral medulloepithelioma manifesting as headache, nausea, and vomiting. Neuroimaging demonstrated a mass containing a cyst in the left frontal lobe. Gross total resection of the tumor with a 1-cm margin was performed under intraoperative monitoring. The histological diagnosis was medulloepithelioma. Stereotactic radiotherapy (total dose 20 Gy) was given to the brain up to 1 cm from the surgical margin. Follow-up neuroimaging 5 years later showed no signs of recurrence. He now attends junior high school, with normal mental and physiological development. Medulloepitheliomas are rare, highly malignant embryonal tumors of the central nervous system. Combined gross total tumor resection and radiotherapy are recommended to obtain the most favorable outcome.
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  • —Case Report—
    Rinsei TEI, Tetsuya MORIMOTO, Kazunori MIYAMOTO, Shuta AKETA, Tatsuo S ...
    2007 Volume 47 Issue 9 Pages 434-437
    Published: 2007
    Released on J-STAGE: September 25, 2007
    JOURNAL OPEN ACCESS
    A 52-year-old woman presented with an intraspinal extradural meningeal cyst in the thoracolumbar region manifesting as progressive sensory disturbance of the bilateral lower extremities. Magnetic resonance imaging and computed tomography myelography showed an extradural meningeal cyst extending from the T-12 to L-4 levels in the thoracolumbar region with a dural defect and a valve-like mechanism developed in the enlarging cyst. Operative findings revealed a dural defect that allowed communication between the extradural cyst cavity and the subarachnoid space. Surgical resection of the cyst wall and repair of the dural defect resolved the symptoms.
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