Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 49, Issue 5
Displaying 1-11 of 11 articles from this issue
Original Articles
  • Tatsuya NAKAMURA, Kazuo OKUCHI, Takeshi MATSUYAMA, Hidetada FUKUSHIMA, ...
    2009 Volume 49 Issue 5 Pages 185-192
    Published: 2009
    Released on J-STAGE: May 25, 2009
    JOURNAL OPEN ACCESS
    Daily changes in serum concentrations of natriuretic peptides and various cardiopulmonary parameters were measured after the onset of subarachnoid hemorrhage (SAH) to investigate the pathogenesis of the cardiac and pulmonary consequences in 15 patients with acute phase SAH, divided into the control group (n = 5) with consciousness continuously preserved from SAH onset to admission, and the consciousness disturbance group (n = 10). Daily changes in serum A-type and B-type natriuretic peptides (ANP and BNP, respectively) were measured for 10 days, and intrathoracic blood volume index and extravascular lung water index (EVLWI) were measured for 5 days by the single transpulmonary thermodilution method. Natriuretic peptides in the consciousness disturbance group showed significantly higher values during the 10-day period, with ANP 119.2 ± 12.4 pg/ml (mean ± standard error of the mean, p = 0.005) on day 2 and BNP 354.1 ± 80.3 pg/ml (p = 0.009) on day 1. EVLWI showed higher values in the consciousness disturbance group compared to the control group throughout the 5-day period. The increases in natriuretic peptide levels and increase in pulmonary extravascular water content found in SAH patients with consciousness disturbance show that load on the left ventricle or atrium as well as pulmonary capillary pressure are increased immediately after onset, supporting the contention that excessive release of catecholamines occurs at this time.
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  • Yu SUZUKI, Katsuyuki TANAKA, Daisuke NEGISHI, Makiko SHIMIZU, Yasuyuki ...
    2009 Volume 49 Issue 5 Pages 193-197
    Published: 2009
    Released on J-STAGE: May 25, 2009
    JOURNAL OPEN ACCESS
    The efficacy of intravenous administration of 400 mg carboplatin/m2 body surface area over 60 minutes combined with hyperbaric oxygenation (HBO) therapy (0.2 MPa for 60 min) was investigated in 6 Japanese patients (aged 36-67 years) with malignant or brainstem gliomas. Plasma ultra-filtrate samples were analyzed by high-performance liquid chromatography to evaluate the relationship between efficacy and pharmacokinetics. Brain tumor response was evaluated by magnetic resonance imaging as a function of maximum plasma concentration, area under the curve, or mean residence time (MRT) for carboplatin. The MRT for carboplatin in the complete or partial response group (mean ± standard deviation 4.3 ± 1.7 hrs; 6 courses in 3 patients) was significantly longer (p < 0.05) than that in the progressive disease group (2.4 ± 0.1 hrs; 3 courses in 3 patients), but maximum plasma concentration and area under the curve showed no differences. These results suggest that HBO therapy prolongs the biological residence time of carboplatin. MRT for carboplatin may be useful for predicting continuation or modification of chemotherapy and/or clinical antitumor effects in patients with malignant gliomas.
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Case Reports
  • —Case Report—
    Masahito KAWABORI, Satoshi KURODA, Naoki NAKAYAMA, Yasuko KENMOTSU, Hi ...
    2009 Volume 49 Issue 5 Pages 198-201
    Published: 2009
    Released on J-STAGE: May 25, 2009
    JOURNAL OPEN ACCESS
    A 78-year-old woman presented with preauricular superficial temporal artery (STA) aneurysm and scalp porocarcinoma, which had both increased in size over 2 years. She had no previous history of head trauma. Three-dimensional (3D) computed tomography (CT) angiography revealed a 4-cm diameter STA aneurysm arising from the main trunk of the left STA and located just lateral to the zygomatic arch. The scalp porocarcinoma was excised by dermatologists. The STA aneurysm was carefully dissected from the surrounding tissues, and was resected after ligation of the proximal STA. Histological examination showed the aneurysm consisted of intima, media, and adventitia, and the diagnosis was atherosclerotic fusiform aneurysm. 3D CT angiography is quite useful to plan surgical strategy for such an unusually large STA aneurysm.
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  • —Case Report—
    Shigeru YAMAGUCHI, Tsutomu KATO, Makoto TAKEDA, Hitoshi IKEDA, Kei KIT ...
    2009 Volume 49 Issue 5 Pages 202-205
    Published: 2009
    Released on J-STAGE: May 25, 2009
    JOURNAL OPEN ACCESS
    A 73-year-old woman presented with diffuse subarachnoid hemorrhage from a ruptured fusiform aneurysm directly arising from the right distal anterior inferior cerebellar artery. Six years before admission, she had undergone stereotactic irradiation for right vestibular schwannoma, under a diagnosis based on neuroimaging. The aneurysm was located within the radiation field. We performed trapping and resection of the aneurysm via a right lateral suboccipital craniotomy, and the patient made a good recovery. Histological examination revealed no evidence of elastic lamina in the aneurysm wall, suggesting pseudoaneurysm caused by radiation-induced vascular injury. Aneurysm formation after radiotherapy is relatively rare and often manifests as fatal hemorrhage. Long-term surviving patients who have received intracranial irradiation should undergo sequential follow up for possible vascular involvement.
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  • —Case Report—
    Hikaru DOI, Shuji HASHIMOTO, Jun-ichi KIRA
    2009 Volume 49 Issue 5 Pages 206-208
    Published: 2009
    Released on J-STAGE: May 25, 2009
    JOURNAL OPEN ACCESS
    A 45-year-old man with a past history of hypertension and hyperlipidemia presented with right dorsal pontine hemorrhage manifesting as transient burning pain in the right orbital region, followed by numbness and mild weakness of the left side of the body. Magnetic resonance imaging showed a hyperintense lesion in the right dorsal pons on T1-weighted and T2-weighted images, but no other abnormalities suggesting vascular lesions in the midbrain, medulla, cerebellum, or cerebrum. These findings were consistent with the subacute stage of small pontine hemorrhage. He was treated to decrease his blood pressure. The symptoms gradually improved and he has suffered neither recurrence of the orbital pain nor migraine for several months after the first episode of headache. The trigeminal nociceptive system in the dorsal lateral pons may be linked to this characteristic pain, as suggested by reports of secondary migraine caused by cavernous hemangioma and arteriovenous malformation, and activation of the dorsal lateral pons during migraine attacks on positron emission tomography.
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  • —Case Report—
    Osamu AKIYAMA, Satoshi TSUTSUMI, Yasuo SUGA, Yusuke ABE, Yukimasa YASU ...
    2009 Volume 49 Issue 5 Pages 209-212
    Published: 2009
    Released on J-STAGE: May 25, 2009
    JOURNAL OPEN ACCESS
    A 25-year-old male presented with unilateral retroorbital dysesthesia persisting for 2 weeks followed by progressive palpebral ptosis without preceding trauma, paranasal sinus surgery, or infectious signs. Neuroophthalmological inspection revealed mildly increased intraocular pressure and exophthalmos on the affected side, without conjunctival chemosis, restriction of the extraocular movements, double vision, or visual impairment. These symptoms did not vary with posture, straining, and Valsalva maneuver. Neuroimaging showed an irregularly-shaped orbital mass without enhancement mainly situated in the medial compartment of the orbit and encasing the optic nerve. Bruit was not audible and abnormal vasculatures were not identified in and around the affected orbit. Transcranial surgical exploration through the surgical window formed by the superior and medial rectus muscles revealed a purplish elastic-soft mass, heterogeneous in consistency and tightly adhering to the surrounding tissue, so cryoprobe-assisted radical tumor resection could not be completed without jeopardizing the optic nerve. The mass was subtotally resected piecemeal without postoperative visual impairment. The histological diagnosis was cavernous hemangioma. Orbital cavernous hemangiomas may present with an atypical appearance which confuses pretreatment diagnosis and makes surgical extirpation more hazardous. Conservative surgery should be indicated for poorly demarcated orbital cavernous hemangiomas considering the usual benign clinical course and postoperative sequelae.
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  • —Case Report—
    Hiroyuki YAMASAKI, Shunji MATSUBARA, Isao SASAKI, Shinji NAGAHIRO
    2009 Volume 49 Issue 5 Pages 213-216
    Published: 2009
    Released on J-STAGE: May 25, 2009
    JOURNAL OPEN ACCESS
    A 69-year-old man presented with a rare case of retinal artery embolization, which occurred as a complication of carotid angioplasty and carotid artery stenting performed for recurrent cerebral infarction. Magnetic resonance imaging and angiography showed right internal carotid artery stenosis with ulceration. Carotid angioplasty and carotid artery stenting were performed using the distal protection system with the PercuSurge GuardWire. However, just after dilation, the patient complained of ocular pain and blurred vision on the right, which was subsequently diagnosed as retinal artery embolization. Heparin was given for 15 hours after stenting, and aspirin and ticlopidine medication were continued. The patient received hyperbaric oxygen therapy for 1 week. The patient’s blurred vision gradually improved, but visual field defect remained. Debris was probably flushed into the external carotid artery, and passed through an anastomosis into the ophthalmic artery, resulting in retinal artery embolization.
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  • —Case Report—
    Misaki KOHAMA, Kensuke MURAKAMI, Toshiki ENDO, Mika WATANABE, Teiji TO ...
    2009 Volume 49 Issue 5 Pages 217-220
    Published: 2009
    Released on J-STAGE: May 25, 2009
    JOURNAL OPEN ACCESS
    A 47-year-old woman presented with an extremely rare case of trochlear nerve neurinoma manifesting as left hemiparesis. Magnetic resonance imaging demonstrated a cystic tumor, 4 cm in diameter, in the right ambient and cerebellopontine cisterns, compressing the midbrain and upper pons. The preoperative diagnosis was trigeminal neurinoma. However, the tumor was identified arising from the trochlear nerve, and was totally removed via the posterior transpetrosal approach. The histological diagnosis was neurinoma. The patient’s hemiparesis improved postoperatively. Preoperative diagnosis of trochlear neurinoma must distinguish the neurological presentations of trochlear and trigeminal neurinomas and to analyze the microanatomy of the tumor and skull base structures on neuroimaging.
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  • —Case Report—
    Masaaki TAKEDA, Satoshi YAMAGUCHI, Kuniki EGUCHI, Teruyuki KAJIUME, Sh ...
    2009 Volume 49 Issue 5 Pages 221-224
    Published: 2009
    Released on J-STAGE: May 25, 2009
    JOURNAL OPEN ACCESS
    A 13-year-old boy presented with an epidural thoracic granulocytic sarcoma manifesting as rapidly progressive paraplegia preceding clinical manifestation of acute myeloid leukemia (AML). Magnetic resonance imaging revealed a thoracic epidural tumor. He underwent emergent laminectomy and the tumor was totally resected. The initial histological diagnosis was malignant lymphoma. The correct diagnosis of epidural granulocytic sarcoma and AML was established based on cell-surface markers and a chromosomal study of the bone marrow cells. A combination of chemotherapy and bone marrow transfusion achieved complete remission of leukemia. No evidence of AML has emerged over the 18-month follow-up period. Granulocytic sarcoma should be considered in the differential diagnosis of an epidural mass in pediatric patients with or without acute leukemia. Immediate diagnosis and appropriate treatment are recommended to prevent leukemic transformation.
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