Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 49, Issue 4
Displaying 1-11 of 11 articles from this issue
Original Articles
  • Kentaro MORI, Takuji YAMAMOTO, Yasuaki NAKAO, Hideo OSADA, Yasukazu HA ...
    2009 Volume 49 Issue 4 Pages 139-145
    Published: 2009
    Released on J-STAGE: April 25, 2009
    JOURNAL OPEN ACCESS
    The vasodilatory effect of intra-cisternal infusion of magnesium sulfate solution was evaluated in 10 patients with symptomatic vasospasm after aneurysmal subarachnoid hemorrhage (SAH) who underwent early clipping surgery. Cisternal drainage was installed in the prepontine and/or sylvian fissures. Carotid angiography was performed immediately after the onset of symptomatic vasospasm, then intra-cisternal infusion of 15 mmol/l magnesium sulfate in Ringer solution was started at 20 ml/hr and continued until day 14. Irrigation was performed from the cisternal tube (inlet) to the spinal drainage (outlet). The cerebrospinal fluid magnesium ion concentration (1.2 ± 0.2 mEq/l) significantly increased after the infusion therapy (6.0 ± 1.7 mEq/l, p < 0.001). Repeat angiography showed vasodilatory effect on the spastic cerebral arteries at 3 hours after the infusion, especially in the arteries near to the site of cisternal drainage placement. The magnesium infusion also caused decreased mean arterial blood velocity in the spastic arteries in 6 of the 7 measured patients (162 ± 38 cm/sec to 114 ± 42 cm/sec, p < 0.001). Finally, 5 of the 10 patients achieved good recovery, 1 patient had moderate disability, 1 patient became severely disabled due to meningitis, and 3 patients were vegetative or dead, due to failure of magnesium irrigation in 1 patient and advanced age in the other 2 (more than 80 years old). This preliminary study indicates that intra-cisternal infusion of magnesium sulfate solution has vasodilatory effect on the spastic cerebral arteries after aneurysmal SAH.
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  • Naoki OKA, Akio SOEDA, Shinji NODA, Toru IWAMA
    2009 Volume 49 Issue 4 Pages 146-151
    Published: 2009
    Released on J-STAGE: April 25, 2009
    JOURNAL OPEN ACCESS
    Brain tumors may arise from and contain cancer stem cells (CSCs) capable of self-renewal, proliferation, and differentiation that recapitulate the parent tumor. These CSCs are thought to be important in gliomagenesis. Detection of CSCs invading the adjacent brain regions is important for the diagnosis and effective treatment of glioblastoma multiforme (GBM). A 57-year-old man presented with an adenoid GBM, and underwent resection of the tumor. Multipotent, self-renewing cells derived from the human adenoid GBM were isolated and identified with the tumor-derived stem cell surface antigen CD133 from whole autopsied patient’s brain. Tumorsphere culture and flow cytometric analysis revealed that 1.02-2.32% of the cells were positive for CD133. Transplantation of cultured tumorspheres into the mice brain resulted in the formation of well-defined tumor masses after 12 weeks. The histological and immunohistochemical characteristics of the xenograft were identical to those of the parent tumor. Examination of the patient’s brain at autopsy showed CD133-positive cells were identified in the brain regions adjacent to the tumor, suggesting that CD133-positive CSCs might be localized to the vascular niche. Methods to localize CSCs may open new approaches for the treatment of brain tumors.
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Case Reports
  • —Case Report—
    Tomofumi NISHIKAWA, Tetsuya UEBA, Motohiro KAJIWARA, Kohsuke YAMASHITA
    2009 Volume 49 Issue 4 Pages 152-154
    Published: 2009
    Released on J-STAGE: April 25, 2009
    JOURNAL OPEN ACCESS
    A 45-year-old man presented with bilateral acute subdural hematomas (ASDHs) without subarachnoid hemorrhage (SAH). He was found comatose in a parked car. Computed tomography showed left frontal intracerebral hemorrhage (ICH) and bilateral ASDHs but no signs of SAH. Magnetic resonance angiography demonstrated an internal carotid artery dorsal wall aneurysm. Emergent surgical intervention was performed. However, he died of cerebral herniation 6 days later. We inferred that massive intracranial bleeding might have ruptured through the cortex and lacerated the arachnoid membrane. Aneurysm rupture generally results in unilateral SDH, whereas trauma is the usual cause of bilateral ASDHs with ICH. Our case suggests that ruptured aneurysm should be considered in patients with non-traumatic bilateral ASDHs without SAH.
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  • —Case Report—
    Kousuke IWAISAKO, Shingo TOYOTA, Masahiro ISHIHARA, Katsuhiko SHIBANO, ...
    2009 Volume 49 Issue 4 Pages 155-158
    Published: 2009
    Released on J-STAGE: April 25, 2009
    JOURNAL OPEN ACCESS
    A 76-year-old woman presented with an enlarged right intracavernous carotid artery aneurysm first identified incidentally when she was hospitalized for thalamic hemorrhage. She was managed conservatively for 1 year, then suffered right total ophthalmoplegia associated with enlargement of the aneurysm. Two months later, she became comatose due to intracerebral hemorrhage in the right temporal lobe. Magnetic resonance imaging demonstrated further enlargement of the aneurysm. Emergency craniotomy found the lateral dural wall of the cavernous sinus was markedly expanded and torn by compression from the aneurysm. Rupture of the aneurysm into the intradural space through this dural defect was confirmed. The aneurysm was trapped after high-flow bypass, but the patient did not recover and died. Symptomatic enlarged intracavernous carotid artery aneurysm is potentially fatal and may indicate prompt surgical management.
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  • —Case Report—
    Naoshi HAGIHARA, Toshi ABE, Fumitaka YOSHIOKA, Mitsuo WATANABE, Kazuo ...
    2009 Volume 49 Issue 4 Pages 159-161
    Published: 2009
    Released on J-STAGE: April 25, 2009
    JOURNAL OPEN ACCESS
    A 37-year-old woman presented with photophobia without visual loss associated with chiasmal compression by an unruptured anterior communicating artery (AcomA) aneurysm. She had suffered progressive photophobia for one year. Neuroimaging indicated an AcomA aneurysm attached to the chiasm. Photophobia was resolved following clipping of the aneurysm. AcomA aneurysm should be considered in patients who experience photophobia without visual loss.
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  • —Case Report—
    Yasuo SASAGAWA, Takuya AKAI, Kenji YAMAMOTO, Tooru MASUOKA, Shoutarou ...
    2009 Volume 49 Issue 4 Pages 162-166
    Published: 2009
    Released on J-STAGE: April 25, 2009
    JOURNAL OPEN ACCESS
    A 55-year-old woman presented with multiple calvarial cavernous hemangiomas manifesting as right frontal swelling. Craniography and computed tomography showed an osteolytic lesion. Magnetic resonance imaging demonstrated multiple intraosseous lesions, and radioisotope bone scintigraphy identified even more numerous lesions. Total resection of the right frontal lesion and cranioplasty was performed. Histological examination confirmed the lesion as a cavernous hemangioma. Computed tomography of the abdomen revealed multiple hepatic lesions, which might be cavernous hemangiomas. Cavernous hemangioma is a rare bony tumor that should be considered in the differential diagnosis of skull tumors. A patient with multiple cavernous hemangiomas should undergo systemic examination to look for latent lesions, and regular follow-up examinations.
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  • —Case Report—
    Hidehiro OKURA, Yasuo SUGA, Osamu AKIYAMA, Kentaro KUDO, Satoshi TSUTS ...
    2009 Volume 49 Issue 4 Pages 167-171
    Published: 2009
    Released on J-STAGE: April 25, 2009
    JOURNAL OPEN ACCESS
    A 61-year-old man presented with a rare pleural malignant mesothelioma of the spine manifesting as progressive weakness of the bilateral lower extremities, numbness in the body and both legs, and dysfunction of the bladder and bowel. He had previous occupational exposure to asbestos while working at a car repair shop and had undergone right panpleuropneumonectomy under a diagnosis of sarcomatous type mesothelioma in the right pleural space. Magnetic resonance imaging of the spine with gadolinium showed an enhanced intramedullary tumor at the T4 level. Operative findings disclosed the clouded and swollen right posterior nerve root, and the pial surface was covered by clouded arachnoid-like membrane. The removed part of the T4 posterior nerve root and intramedullary tumor revealed malignant mesothelioma with invasion spreading along the posterior nerve root. He died of respiratory failure 3 months after the diagnosis. This case shows that spinal metastasis must be considered if a patient with pleural malignant mesothelioma shows neurological worsening and neuroimaging shows an abnormal lesion in the thoracic spinal cord. However, the patient’s neurological condition is very difficult to improve in the presence of spinal cord infiltration.
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  • —Two Case Reports—
    Melih CEKINMEZ, Kadir TUFAN, Orhan SEN, Hakan CANER
    2009 Volume 49 Issue 4 Pages 172-174
    Published: 2009
    Released on J-STAGE: April 25, 2009
    JOURNAL OPEN ACCESS
    Two 8-year-old boys presented with complaints of torticollis and pain on neck turning. Both patients had a history of throat infection. Radiography and computed tomography demonstrated atlanto-axial subluxation. The patients were treated under diagnoses of Grisel’s syndrome, unilateral or bilateral subluxation of the atlas on the axis associated with infection in the head or neck. Both patients were treated conservatively with bed rest, muscle relaxants, non-steroid anti-inflammatory agents, and immobilization with a soft cervical collar and cervical halter traction. The torticollis had resolved and reduction of atlanto-axial subluxation was confirmed within 2 weeks in both patients. Early diagnosis of Grisel’s syndrome with appropriate antibiotics and a cervical collar, with halter traction if necessary, can achieve good outcome. Surgical treatment for the reduction of atlanto-axial subluxation should be reserved for persistent or recurrent cases.
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Technical Notes
  • —Technical Note—
    Satoru SHIMIZU, Hiroyuki HAGIWARA, Satoshi HATTORI, Kenji NAKAYAMA, Ki ...
    2009 Volume 49 Issue 4 Pages 175-178
    Published: 2009
    Released on J-STAGE: April 25, 2009
    JOURNAL OPEN ACCESS
    Lumboperitoneal shunt placement requires access to the lumbar theca in the lateral position, followed by subsequent laparotomy in the supine position. This position change and repeat draping are bothersome, especially in heavy patients, so we developed a method that facilitates changing the patient position while keeping the surgical drapes in place. An oblong plastic board covered with Teflon-coated glassfiber cloth and surrounded by a nylon-cloth sleeve is used. The sleeve can be easily moved over the board, so patients can be moved in the transverse direction with minimal pushing force. The patient is placed in the lateral position on the board on the operating table and draped from the back to the abdomen. After catheter insertion into the lumbar theca and introduction of a subcutaneous tunnel to the flank, the patient is pushed in the ventral direction, moved to the opposite edge of the operating table, and the position is changed from lateral to supine, leaving the original drape intact. Finally, a catheter is placed by laparotomy. We were able to change position easily in 20 patients weighing 47-85 kg (mean 69.6 kg). This technique reduces the labor required for position change and preserves sterility.
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  • —Technical Note—
    Hiroshi TENJIN, Ayako MANDAI, Daisuke UMEBAYASHI, Shinji YAMAMOTO, Yas ...
    2009 Volume 49 Issue 4 Pages 179-183
    Published: 2009
    Released on J-STAGE: April 25, 2009
    JOURNAL OPEN ACCESS
    An accurate, safe, and convenient method for performing percutaneous vertebroplasty (PVP) under three-dimensional (3D) radiography guidance has been developed. Six PVP procedures were performed in 5 elderly stroke patients complaining of back pain caused by compressive fracture which interfered with further rehabilitation. T1-weighted magnetic resonance imaging showed low intensity and T2-weighted imaging showed high intensity in the fractured vertebral body. The most suitable trajectory for passing the lateral mass of the lamina and pedicle, and reaching the vertebral body was identified on the axial view of 3D radiography. A 13-gauge needle was advanced appropriately in all patients, and improvement of back pain was obtained after injection of polymethylmethacrylate. No major complications occurred in any patient. PVP under 3D radiography guidance is an accurate, safe, and convenient method.
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