Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 48, Issue 4
Displaying 1-11 of 11 articles from this issue
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Review Article
  • The Shaken Baby Syndrome: An Odyssey
    —II Origins and Further Hypotheses—
    Ronald H. USCINSKI, Dennis K. MCBRIDE
    2008 Volume 48 Issue 4 Pages 151-156
    Published: 2008
    Released on J-STAGE: April 24, 2008
    DOIhttps://doi.org/10.2176/nmc.48.151
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    Subdural bleeding in the so-called “shaken baby syndrome” is recognized as a hallmark of this syndrome, and is often noted as chronic in nature, indicating an earlier time of origin than clinical presentation. In infants and neonates, the timeframe for generating such chronic intracranial bleeding is therefore limited. Neurosurgical, obstetric, and pediatric literature all recognize the significance of birth trauma in the generation of intracranial bleeding. This possibility is explored further here, with emphasis on features peculiar to Homo sapiens predisposing to intracranial bleeding during this timeframe. Encephalization and bipedalism combine to render the infant and mother susceptible to injury at birth.
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Original Article
  • Potential of Magnetic Resonance Plaque Imaging Using Superparamagnetic Particles of Iron Oxide for the Detection of Carotid Plaque
    Ichiro KAWAHARA, Morito NAKAMOTO, Naoki KITAGAWA, Keisuke TSUTSUMI, Iz ...
    2008 Volume 48 Issue 4 Pages 157-162
    Published: 2008
    Released on J-STAGE: April 24, 2008
    DOIhttps://doi.org/10.2176/nmc.48.157
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    Macrophages and by-products are important in plaque destabilization in atherosclerosis. Ultra-small superparamagnetic particles of iron oxide (SPIO)-enhanced magnetic resonance (MR) imaging may be suitable for the detection of macrophages in atherosclerotic plaques. The present study investigated the potential of MR plaque imaging using SPIO in 10 patients scheduled for carotid endarterectomy before and 24-43 hours after administration of SPIO (fercarbotran, 0.016 ml/kg). Three-dimensional gradient recalled acquisition in the steady state (3D-GRASS) was used for detecting macrophages within plaques. Signal loss on the post-contrast 3D-GRASS images was found in 5 of 10 cases, and accumulation of SPIO particles in the vessel wall was confirmed in 4 of these 5 cases. Intracytoplasmic localization of SPIO particles within recruited macrophages was verified by double staining analysis. A correlation between MR plaque imaging using SPIO and localization of macrophages was demonstrated in 6 of 10 patients. This study indicates that MR plaque imaging using SPIO is a potential functional imaging tool to detect infiltration of macrophages in human atherosclerotic carotid plaque.
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Case Reports
  • Usefulness of Balloon Test Occlusion in the Diagnosis of Glossopharyngeal Neuralgia
    —Case Report—
    Shu HASEGAWA, Motohiro MORIOKA, Yutaka KAI, Jun-ichi KURATSU
    2008 Volume 48 Issue 4 Pages 163-166
    Published: 2008
    Released on J-STAGE: April 24, 2008
    DOIhttps://doi.org/10.2176/nmc.48.163
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    A 67-year-old man presented with glossopharyngeal neuralgia (GPN) manifesting as severe paroxysmal pharyngeal and retroauricular pain not controlled by medical treatment. Constructive interference in steady state magnetic resonance imaging suggested that the responsible vessel was the right vertebral artery (VA). As carbamazepine had some limited effect, we reviewed the appropriateness of microvascular decompression surgery. Balloon test occlusion of the VA was performed to confirm that the GPN was due to right VA pulsation. The neuralgia disappeared and reappeared with balloon inflation and deflation. Therefore, the VA was moved to decompress the glossopharyngeal nerve. The patient was pain-free after surgery. Balloon test occlusion may be useful in the diagnosis of GPN and the selection of the most appropriate surgical treatment.
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  • Traumatic Vertebro-vertebral Arteriovenous Fistula Manifesting as Radiculopathy
    —Case Report—
    Manabu SHIRAKAWA, Tatsuya NISHIOKA, Kohsuke YAMASHITA, Yukio MAEDA, No ...
    2008 Volume 48 Issue 4 Pages 167-170
    Published: 2008
    Released on J-STAGE: April 24, 2008
    DOIhttps://doi.org/10.2176/nmc.48.167
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    A 58-year-old man presented with a traumatic vertebro-vertebral arteriovenous fistula (VVAVF) after attempting suicide by thrusting scissors into his right anterior cervical region. Two months later he noticed weakness and numbness of the right upper extremity. Examination revealed bruit in the right neck, no cranial nerve palsy, and weakness of the right deltoid and biceps muscles. Hypalgesia and hypesthesia were noted in the right C5 and C6 dermatomes. Magnetic resonance imaging demonstrated a mass lesion on the right ventral aspect of the spinal canal from C2 to C7. Right vertebral artery angiography showed a pseudoaneurysm of the right vertebral artery and a high-flow arteriovenous fistula between the right vertebral artery and vein. The right vertebral artery was occluded with detachable coils because the fistula showed high blood flow and the right posterior inferior cerebellar artery was well opacified from the left vertebral artery. This procedure resulted in complete obliteration of the arteriovenous fistula. The preoperative motor and sensory symptoms improved. Endovascular treatment by coil embolization was effective in our patient with traumatic VVAVF.
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  • Posterior Fossa Dural Arteriovenous Fistula As a Probable Cause of Congestive Myelopathy
    —Case Report—
    Satoshi TSUTSUMI, Yukimasa YASUMOTO, Masanori ITO, Hidenori OISHI, Haj ...
    2008 Volume 48 Issue 4 Pages 171-175
    Published: 2008
    Released on J-STAGE: April 24, 2008
    DOIhttps://doi.org/10.2176/nmc.48.171
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    A 62-year-old female suffered severe occipitalgia followed by progressive tetraparesis and bulbar symptoms, although tinnitus in the left ear persisting for more than 1 year resolved spontaneously after the onset. Cerebral magnetic resonance (MR) imaging revealed swelling in the lower brainstem, and cervical T2-weighted MR imaging showed diffuse intramedullary hyperintensity in the medulla oblongata extending downward to the upper thoracic cord. Rim-like enhancement was localized at the C2 level after gadolinium administration. Extensive blood and cerebrospinal fluid examinations and whole body scintigraphy showed no indications of the underlying pathology. She underwent open biopsy for histological verification and decompressive maneuver to the cord. Sparse arterial distribution, and collapsed and partially thrombosed veins were recognized on the dorsal surface of the cord. Midline myelotomy yielded creamy fluid that proved to be necrotic tissue. Histological examination found the venous wall was thickened with lymphocytic infiltration. Her tetraparesis showed mild improvement postoperatively with marked resolution of the intramedullary hyperintensity on MR imaging. Postoperative cerebral angiography revealed a posterior fossa dural arteriovenous fistula (dAVF) fed by the left ascending pharyngeal and occipital arteries, with venous reflux to the ipsilateral inferior petrosal sinus. No venous drainage was found via the perimedullary vein. The dAVF was completely obliterated by transvenous coil embolization. We considered that the dAVF might have caused the congestive myelopathy. Decompressive maneuver may provide effective management for necrotizing myelopathy in selected cases.
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  • Intracerebral Hematoma Complicated With Brain Abscess in an Infant
    —Case Report—
    Olcay ESER, Murat COSAR, Adem ASLAN, Resit KOKEN, Fatma AKTEPE, Betul ...
    2008 Volume 48 Issue 4 Pages 176-178
    Published: 2008
    Released on J-STAGE: April 24, 2008
    DOIhttps://doi.org/10.2176/nmc.48.176
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    A 45-day-old infant presented with a rare case of intracerebral hematoma complicated with brain abscess which developed after vitamin K deficiency. He was admitted to our emergency department with complaints of fever and confusion. Physical, neurological, and laboratory examinations and cranial computed tomography identified vitamin K deficiency and intracerebral hematoma. He started to suffer convulsions. The patient underwent surgery. A brain abscess was discovered with an intracerebral hematoma. The intracerebral hematoma and abscess were evacuated and antibiotic therapy was initiated. Convulsions became rare and were controlled with midozalam administration. Follow-up computed tomography after 6 months showed encephalomalacic changes in the temporoparietal area. If feeding depends only on human milk, the amount of vitamin K prophylaxis given to neonates should be increased to support vitamin K related factors.
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  • Two-level Ligamentum Flavum Hematoma in the Lumbar Spine
    —Case Report—
    Naohisa MIYAKOSHI, Yuji KASUKAWA, Shigeru ANDO, Yoichi SHIMADA
    2008 Volume 48 Issue 4 Pages 179-182
    Published: 2008
    Released on J-STAGE: April 24, 2008
    DOIhttps://doi.org/10.2176/nmc.48.179
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    Ligamentum flavum hematoma is a rare cause of spinal root or cord compression that usually occurs at a single level. No case of multiple-level ligamentum flavum hematoma has previously been reported. We report an extremely rare case of double, contiguous ligamentum flavum hematomas in the lumbar spine. A 71-year-old man with hypertension and degenerative lumbar scoliosis presented with pain and muscle weakness in the left lower extremity after physical exertion. Magnetic resonance imaging of the lumbar spine showed severe spinal stenosis caused by two-level ligamentum flavum hematoma (L3-L4 and L4-L5). Both hematomas were completely removed and the diagnosis was histologically confirmed. Symptoms completely resolved after surgery. Despite being extremely rare, ligamentum flavum hematoma with involvement of multiple levels may be observed.
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  • Cervical Ligamentum Flavum Ossification
    —Two Case Reports—
    Kyongsong KIM, Toyohiko ISU, Ryutaro NOMURA, Shiro KOBAYASHI, Akira TE ...
    2008 Volume 48 Issue 4 Pages 183-187
    Published: 2008
    Released on J-STAGE: April 24, 2008
    DOIhttps://doi.org/10.2176/nmc.48.183
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    A 58-year-old woman (Case 1) presented with disturbance of fine movement and gait. Magnetic resonance (MR) imaging and computed tomography (CT) demonstrated bilateral ossified ligamentum flava at the C3-4 and C4-5 levels and severe cervical canal stenosis. She underwent posterior decompression and despite strong adhesion to the dura mater, the ossified ligamentum flavum was removed without inducing liquorrhea. Her neurological symptoms improved postoperatively. A 63-year-old man (Case 2) was admitted with disturbance of fine movement and gait that had developed gradually. MR imaging and postmyelography CT demonstrated cervical canal stenosis via the ossified posterior longitudinal ligament at the C4-6 levels and ossified ligamentum flavum on the right at the C4-5 levels. He underwent right posterior decompression of C4-5. After right hemilaminectomy of C4-5, the ligamentum flavum was exposed. Neither the ligamentum flavum nor the ossification had adhered to the dura mater, so complete removal was successful and he recovered completely from his neurological symptoms. Diffuse-type ossified ligamentum flavum had adhesion to the dura mater, as in our Case 1, whereas focal-type ossified ligamentum flavum did not, as in our Case 2. This information is useful for treatment planning.
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  • Migration of a Bullet in the Lumbar Intervertebral Disc Space Causing Back Pain
    —Case Report—
    Davut CEYLAN, Murat COSAR
    2008 Volume 48 Issue 4 Pages 188-190
    Published: 2008
    Released on J-STAGE: April 24, 2008
    DOIhttps://doi.org/10.2176/nmc.48.188
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    A 41-year-old man presented with low-velocity gunshot injury in the right abdomen. Neuroimaging showed the bullet located in the L2-3 intervertebral disc space, but neurological examination found no abnormalities. Exploratory laparotomy was performed because of retroperitoneal hematoma. Two months after the gunshot injury, the patient presented with severe low back pain. Serial neuroimaging showed that the bullet had migrated in the intervertebral disc space. The bullet was removed via right L2 hemilaminectomy. The patient had no complaints after the operation. Early recognition and surgical intervention for bullets embedded in the intervertebral disc space may present with neurological and related complications.
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Technical Note
  • Supratentorial Craniotomy Using a Threadwire Saw
    —Technical Note—
    Satoru SHIMIZU, Tomoko MIYAZAKI, Sachio SUZUKI, Masaru YAMADA, Satoshi ...
    2008 Volume 48 Issue 4 Pages 191-194
    Published: 2008
    Released on J-STAGE: April 24, 2008
    DOIhttps://doi.org/10.2176/nmc.48.191
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    An alternative technique for cutting the bone flap in supratentorial craniotomy uses a threadwire saw (T-saw), originally developed for spinal surgery. After placing a burr hole at each corner of the intended craniotomy, osteotomy is performed between adjacent burr holes using a craniotome, leaving a bony bridge of approximately 1/3 of the length of the osteotomy. The T-saw is introduced between adjacent burr holes through the epidural space and the bridge is cut with reciprocating strokes. The narrow beveled cut reduces the bone gap for fitted bone flap fixation. On closure, the bridge firmly supports the flap and only sutures are needed for fixation. A minimal amount of filler is required to fill the bone gap. Successful bone flap fixation was obtained in more than 100 cases. No technique-related complications such as dural laceration or flap displacement occurred. Osteotomy using a T-saw was somewhat time-consuming, but cutting efficiency was improved with a Diamond T-saw, featuring a section of cable covered with diamond particles. This method is ideal for bone cuts in cosmetic cranioplasty; is easy and safe to perform, is inexpensive, and avoids the need for flap fixation with metal devices.
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Editorial Committee
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