Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 50, Issue 6
Displaying 1-21 of 21 articles from this issue
Original Articles
  • Shinya ICHIMURA, Takayuki OHIRA, Masahito KOBAYASHI, Tadashige KANO, T ...
    Article type: Original Article
    2010 Volume 50 Issue 6 Pages 441-448
    Published: 2010
    Released on J-STAGE: June 25, 2010
    JOURNAL OPEN ACCESS
    Cognitive function has not been well studied after neurosurgery for posterior fossa lesions despite its potential importance in determining surgical indications and approaches. The present study evaluated changes in cognitive functions after posterior fossa surgery to detect any differences between the middle cranial fossa and lateral suboccipital approaches in 50 patients with posterior fossa lesions such as tumors and vascular diseases. Twenty-five patients underwent surgery via the middle fossa and 25 via the lateral suboccipital approaches. Computerized test battery (CogStateTM) and conventional neuropsychological tests (serial seven-word learning test and mini-mental state examination) were examined before, 1 month after, and 3 months after surgery. All scores of the neuropsychological tests remained within normal limits after surgery. However, the scores of one computerized test battery and serial seven-word learning tests decreased significantly 1 month after surgery and recovered within 3 months, indicating temporary deterioration of short-term memory in the middle fossa group. The computerized tests detected significantly larger numbers of patients with worsened results than the conventional tests. The middle fossa approach and operation time showed correlations with the postoperative neuropsychological declines. The computerized tests could be performed easily and were beneficial for detecting subtle changes of the cognitive function after surgery. Cognitive function, especially short-term memory, may decline temporarily with the middle fossa approach and long operation time.
    Download PDF (251K)
  • Atsushi KATSUMATA, Kenji SUGIU, Koji TOKUNAGA, Noboru KUSAKA, Kyoichi ...
    Article type: Original Article
    2010 Volume 50 Issue 6 Pages 449-455
    Published: 2010
    Released on J-STAGE: June 25, 2010
    JOURNAL OPEN ACCESS
    Vascular endothelial growth factor (VEGF) administration has recently been assessed as a therapeutic strategy for ischemic diseases including brain ischemia because of its angiogenic effect. However, VEGF also causes detrimental adverse effects by increasing vascular permeability. This study examined whether plasmid human VEGF (phVEGF) administration induced angiogenic effects in the rat brain ischemia model caused by permanent ligation of both common carotid arteries, and investigated the occurrence of adverse effects. Administration of various doses (0-200 μg) of phVEGF in the temporal muscle was followed by encephalo-myo-synangiosis. Thirty days after treatment, the numbers and areas of capillaries per field in the extracted brains were analyzed with the National Institutes of Health Image software program. The maximal angiogenic effect occurred with a 100 μg dose of phVEGF in the numbers and areas of capillaries in the VEGF-treated brains. Histological examination showed no apparent adverse effects in the brain parenchyma even at the highest administration dose (200 μg) of phVEGF. The maximal angiogenic effect at the optimal dose of phVEGF can be considered under the threshold to cause serious adverse effects in the rat brain.
    Download PDF (517K)
  • Yoshihisa KITAMURA, Motohiro NOMURA, Hiroshi SHIMA, Nobumasa KUWANA, T ...
    Article type: Original Article
    2010 Volume 50 Issue 6 Pages 456-460
    Published: 2010
    Released on J-STAGE: June 25, 2010
    JOURNAL OPEN ACCESS
    Acute lung injury (ALI) associated with systemic inflammatory response syndrome (SIRS) is a systemic complication following subarachnoid hemorrhage (SAH), but the incidence and influence on prognosis are unclear. The incidences of SIRS and ALI were surveyed in a prospective multicenter study of 96 patients admitted for SAH between December 2004 and June 2007. Hunt and Hess grade and Glasgow Outcome Scale score were also investigated. Forty-eight patients were diagnosed with SIRS, and 26 developed ALI within 4 weeks of admission. Nineteen of the 26 patients with ALI were complicated by SIRS, and 7 developed only ALI. Thirteen of the 19 patients complicated by SIRS and ALI died, and this mortality was higher than for patients with only SIRS (3/29) and only ALI (1/7). Multivariate analysis of the development of SIRS and/or ALI and Hunt and Hess grade as risk factors associated with aggravation of the outcome showed that complication with SIRS and ALI had the highest risk. Half of the patients admitted for SAH developed SIRS, and more than 25% developed ALI. The prognosis for patients complicated by SIRS and ALI was poor, which indicates that prevention and active treatment of these two pathologies are important.
    Download PDF (222K)
  • Ryuta NAKAE, Hidetaka ONDA, Shoji YOKOBORI, Takashi ARAKI, Akira FUSE, ...
    Article type: Original Article
    2010 Volume 50 Issue 6 Pages 461-465
    Published: 2010
    Released on J-STAGE: June 25, 2010
    JOURNAL OPEN ACCESS
    Patients with degenerative diseases of the cervical spine, such as ossification of the posterior longitudinal ligament, spondylosis, and canal stenosis, sometimes present with acute spinal cord injury caused by minor trauma. However, the relative risk of cervical cord injury with these diseases is unknown. The clinical and radiological features of 94 elderly patients with head injury, 57 men and 37 women aged from 65 to 98 years (mean 76.6 years), were retrospectively analyzed to assess the association of spinal cord injury with degenerative cervical diseases. Degenerative cervical diseases were present in 25 patients, and spinal cord injury was more common in the patients with degenerative diseases (11/25 patients) than in the patients without such diseases (3/69 patients; relative risk = 10.2). The incidence of degenerative cervical diseases seems to be increasing in Japan because life expectancy has increased and the elderly are a rapidly growing part of the population. A fall while walking or cycling is a common mechanism of head injury and/or cervical cord injury in the elderly. To decrease the occurrence of cervical myelopathy, prevention by increasing social awareness and avoiding traffic accidents and falls is important.
    Download PDF (169K)
Case Reports
  • —Case Report—
    Kouichi MISAKI, Naoyuki UCHIYAMA, Hisashi NITTA, Jun-ichiro HAMADA
    Article type: Case Report
    2010 Volume 50 Issue 6 Pages 466-469
    Published: 2010
    Released on J-STAGE: June 25, 2010
    JOURNAL OPEN ACCESS
    A 65-year-old man presented with a hyperplastic anomalous anterior choroidal artery (AChA) associated with a ruptured internal carotid artery aneurysm at the origin of a perforating artery manifesting as sudden onset of headache and vomiting. The aneurysm was too small for endovascular embolization, so we performed open surgery via the left pterional approach. Aneurysm clipping with preservation of the perforator was impossible, so we clipped the aneurysm neck and sacrificed the perforator. We also performed dome clipping because dome puncture resulted in continuous bleeding. Head computed tomography obtained 3 days after the operation showed cerebral infarction at the territory of the sacrificed perforator, but the patient suffered no neurological deficits. This case of internal carotid artery aneurysm with a perforating artery arising from the aneurysm dome shows that sacrifice of the perforator may be necessary to prevent rebleeding.
    Download PDF (317K)
  • —Two Case Reports—
    Hiroyuki JIMBO, Yukio IKEDA, Hitoshi IZAWA, Kuninori OTSUKA, Jo HARAOK ...
    Article type: Case Report
    2010 Volume 50 Issue 6 Pages 470-475
    Published: 2010
    Released on J-STAGE: June 25, 2010
    JOURNAL OPEN ACCESS
    Most arteriovenous malformations (AVMs) associated with the meningeal artery in the anterior cranial fossa are the pure dural type, and mixed pial-dural AVMs are rare. Two types of mixed pial-dural AVM occur in the anterior cranial fossa according to the shunting point: one with the nidus in the brain parenchyma of the frontal lobe, and the other with the shunting point in the dura mater. We describe two patients with AVMs fed by the anterior ethmoidal arteries and the persistent primitive olfactory artery, with the nidus located in the pure brain parenchyma of the inferior aspect of frontal lobe, and drained via an abnormal cortical vein into the cavernous and superior sagittal sinuses. The importance of occluding the venous outflow to obliterate intracranial dural arteriovenous fistula (AVF) is emphasized. However, removal of the nidus in the brain parenchyma is required. The presence of a pial feeder should be considered before diagnosis of dural AVF of the anterior cranial fossa, and preoperative detailed evaluation for the pial supply and shunting point is mandatory.
    Download PDF (400K)
  • —Case Report—
    Tomoji TAKIGAWA, Yuji MATSUMARU, Mikito HAYAKAWA, Noriaki FUKUHARA, Ma ...
    Article type: Case Report
    2010 Volume 50 Issue 6 Pages 475-478
    Published: 2010
    Released on J-STAGE: June 25, 2010
    JOURNAL OPEN ACCESS
    A 41-year-old woman presented with progressive hemianopsia caused by compression of the lateral geniculate body by the dilated basal vein draining a contralateral frontal arteriovenous malformation (AVM). Magnetic resonance (MR) imaging revealed left frontal AVM and right lateral geniculate body compression due to the dilated basal vein. Emergent presurgical transarterial embolization and surgical removal were performed. Left hemianopsia completely recovered 3 months after surgery and MR imaging indicated improvement of the compression of the lateral geniculate body. Direct mechanical compression of the enlarged drainage vein is one of the causes of homonymous hemianopsia. Early surgical treatment is recommended to obtain a rapid recovery.
    Download PDF (468K)
  • —Case Report—
    Hao-Kuang WANG, Po-Chou LILIANG, Cheng-Loong LIANG, Kang LU, Kuo-Chuan ...
    Article type: Case Report
    2010 Volume 50 Issue 6 Pages 479-481
    Published: 2010
    Released on J-STAGE: June 25, 2010
    JOURNAL OPEN ACCESS
    A 51-year-old woman presented with a rare case of spontaneous intracranial hypotension (SIH) complicated by a delayed subdural hematoma (SDH) that required surgical evacuation 2 months after epidural blood patching (EBP). Subdural fluid collections are common among patients with SIH. These fluid collections vary in appearance from thin subdural hygromas to rare large SDHs associated with significant mass effect. Most subdural fluid collections can be safely managed by conservative treatment or EBP. The present clinical course and imaging findings illustrate the possible sequential complications of EBP in patients with SIH.
    Download PDF (208K)
  • —Case Report—
    Yasushi IIMURA, Satoshi TSUTSUMI, Yumiko MITOME, Yasuomi NONAKA, Yusuk ...
    Article type: Case Report
    2010 Volume 50 Issue 6 Pages 482-484
    Published: 2010
    Released on J-STAGE: June 25, 2010
    JOURNAL OPEN ACCESS
    A 6-month-old boy presented with a rare case of infected subdural hemorrhage manifesting as sustained fever and focal seizure. The boy had been well without contributory medical history. Physical examination found no neurological impairment with intact superficial appearance and soft fontanels. The parents denied recent head trauma or shaking injury. Blood examination was normal except for white blood cell count of 19200/μl and C-reactive protein level of 6.7 mg/dl. Bacterial culture of nasal swab, urine, stool, and venous blood samples was negative. Cerebrospinal fluid examination showed normal findings. Cranial computed tomography revealed an expansive subdural fluid collection in the right frontotemporal region. Magnetic resonance imaging showed the lesion as hypointense on T1- and hyperintense on T2-weighted images with intense enhancement of the outer membrane. The patient underwent burr-hole drainage, which identified the subdural hematoma encapsulated in a thick outer membrane and intermingled with pus material. Culture of the pus identified Escherichia coli. The patient received antibiotic therapy for 8 weeks that resulted in complete resolution of the infection. We assumed that preexisting subdural hematoma formed after minor head trauma was followed by hematogenous infection by E. coli. Infected subdural hematoma is possible in infants presenting with subdural hemorrhage with clinical symptoms of bacteremia.
    Download PDF (251K)
  • —Case Report—
    Masanori KURIMOTO, Kyo NOGUCHI, Shoichi NAGAI, Takashi ASAHI, Naoya KU ...
    Article type: Case Report
    2010 Volume 50 Issue 6 Pages 485-487
    Published: 2010
    Released on J-STAGE: June 25, 2010
    JOURNAL OPEN ACCESS
    A 55-year-old man presented with gait disturbance, incontinence, and back pain. He had a medical history of schizophrenia for the past 35 years. Computed tomography (CT) and magnetic resonance imaging suggested thoracic vertebral hemangioma. Dynamic CT incidentally detected a hepatic hemangioma. Laminectomy of T3 and T4, resection of the epidural hemangioma, and rigid instrumentation between T1 and T6 using rod and hook systems were performed. Postoperatively, his symptoms completely disappeared and the histological diagnosis was capillary hemangioma. Schizophrenic patients have diminished sensitivity to pain or other symptoms, so neurological symptoms may become severe. However, early and appropriate treatment can result in satisfactory neurological outcome. The patient had a rare association of vertebral hemangioma and hepatic hemangioma, which may be a chance occurrence.
    Download PDF (278K)
  • —Case Report—
    Atsushi ARAI, Masamitsu NISHIHARA, Takashi SASAYAMA, Hideo AIHARA, Koh ...
    Article type: Case Report
    2010 Volume 50 Issue 6 Pages 488-491
    Published: 2010
    Released on J-STAGE: June 25, 2010
    JOURNAL OPEN ACCESS
    A 55-year-old woman presented with a rare xanthogranuloma of the sellar region after complaining of severe headache and visual disturbance 3 months previously. Clinical examination showed she was alert with early signs of bitemporal hemianopsia. Endocrinological examination revealed hypopituitarism. Magnetic resonance imaging showed an intrasellar mass extending into the suprasellar region and compressing the optic chiasma, which appeared homogeneously hyperintense on T1-weighted images. Endonasal transsphenoidal resection of the tumor was performed. Histological examination disclosed granulomatous tissue with cholesterol clefts, hemosiderin deposits, fibrous tissues, and macrophages containing rich fat. The histological diagnosis was xanthogranuloma of the sellar region. Her visual symptoms recovered postoperatively although the hypopituitarism remained. Xanthogranuloma of the sellar region is rare, but must be considered in the differential diagnosis of tumors of the sellar region.
    Download PDF (277K)
  • —Case Report—
    Taro KOMURO, Shinichiro OKAMOTO
    Article type: Case Report
    2010 Volume 50 Issue 6 Pages 492-494
    Published: 2010
    Released on J-STAGE: June 25, 2010
    JOURNAL OPEN ACCESS
    A 48-year-old female presented with a rare case of adult T-cell leukemia/lymphoma (ATL) occurring as only intracerebral mass lesion manifesting as progressively worsening headaches, transient mild weakness of the left lower extremity, bilateral papilledema, and left homonymous hemianopsia. Laboratory examination showed transient leukocytosis (15900/μl) without febrile episode or elevation of C-reactive protein. Neuroimaging revealed a solitary enhanced mass lesion in the right occipital lobe adjacent to the choroid plexus with prominent perifocal edema. The patient underwent gross total removal, and the histological diagnosis was intracerebral ATL. She underwent radiation therapy and chemotherapy after local recurrence and metastasis to an optic nerve. The lesions had disappeared on magnetic resonance imaging with contrast medium 10 months after onset and no recurrence was detected even 5 years later. Intracerebral ATL should be considered in the differential diagnosis of intracerebral mass without leukemia or systemic lymphoma.
    Download PDF (302K)
  • —Case Report—
    Shinya YAMAGUCHI, Satoshi O. SUZUKI, Yoshihiro MATSUO, Toshio UESAKA, ...
    Article type: Case Report
    2010 Volume 50 Issue 6 Pages 495-498
    Published: 2010
    Released on J-STAGE: June 25, 2010
    JOURNAL OPEN ACCESS
    A 24-year-old female presented with an unusual case of hypothalamic hamartoma manifesting as seizure. Neuroimaging findings were atypical, showing the large tumor (maximum diameter, 50 mm) with a cystic component and calcification. Surgery was performed and histological examination demonstrated heterotopia. Hamartoma should be considered in the differential diagnosis of a suprasellar, non-enhanced mass attached to the hypothalamus. Excessive unnecessary surgery should be avoided, and intraoperative pathological examination may lead to enhanced assessment and better outcomes.
    Download PDF (341K)
  • —Case Report—
    Satoshi TSUTSUMI, Yusuke ABE, Yukimasa YASUMOTO, Saori SHIONO, Masanor ...
    Article type: Case Report
    2010 Volume 50 Issue 6 Pages 499-502
    Published: 2010
    Released on J-STAGE: June 25, 2010
    JOURNAL OPEN ACCESS
    A 39-year-old male without contributory medical history had sustained progressive double vision, ptosis, and trigeminal pain for 2 weeks. Physical examination revealed total ophthalmoplegia and visual field defect with normal blood examination and chest radiography. Cranial computed tomography revealed a hyperdense mass in the left frontotemporal fossae with bony erosion. Magnetic resonance imaging confirmed a broad-based, intensely enhanced extraaxial tumor of 4×4×4 cm diameter with dural tail sign. Cerebral angiography demonstrated insignificant blood supply both from the internal carotid and middle meningeal arteries. Nearly total tumor resection was achieved via orbitofrontotemporal craniotomy. Intraoperative findings revealed the extraaxial tumor with broad attachment to the dura mater and invasion to the optic and oculomotor nerves. Histological examination revealed hypercellular tumor with significant cell atypism, mitotic activity, and focal necrosis. Immunohistochemical staining was positive for AE1/3 and c-kit, but negative for glial fibrillary acidic protein. Systemic examination performed postoperatively revealed a thymic tumor without additional remote lesions. The final diagnosis was metastatic brain tumor from thymic carcinoma. Rapid progression of neurological impairment inconsistent with a benign extraaxial tumor needs prompt surgical intervention.
    Download PDF (417K)
  • —Case Report—
    Satoshi TSUTSUMI, Yukimasa YASUMOTO, Hideki OIZUMI, Masanori ITO
    Article type: Case Report
    2010 Volume 50 Issue 6 Pages 502-505
    Published: 2010
    Released on J-STAGE: June 25, 2010
    JOURNAL OPEN ACCESS
    A 60-year-old male was first treated for World Health Organization (WHO) grade II chondrosarcoma arising from the ring finger manifesting as painful swelling. Four years later, the patient presented with cerebral infarction. Echocardiography revealed a tumor occupying the left atrium. He underwent open heart surgery and the tumor was identified as metastatic chondrosarcoma with malignant transformation to WHO grade III lesion. Five months following the cardiac surgery, the patient suffered generalized seizure. Cerebral magnetic resonance imaging revealed multiple parenchymal lesions. Surgical tumor extirpation confirmed the histological diagnosis as metastatic grade III chondrosarcoma. Gamma knife radiosurgery (GKS) performed postoperatively controlled the parenchymal lesions for more than 10 months without relapse. GKS may be effective for the treatment of brain metastasis from high grade chondrosarcoma.
    Download PDF (352K)
  • —Case Report—
    Masaya NAGAISHI, Ryotaro SUZUKI, Yoshihiro TANAKA, Katumi HOYA, Yoshit ...
    Article type: Case Report
    2010 Volume 50 Issue 6 Pages 505-508
    Published: 2010
    Released on J-STAGE: June 25, 2010
    JOURNAL OPEN ACCESS
    An 11-year-old boy presented with pineal pure germinoma with spinal dissemination manifesting as a 1-month history of ocular motility disturbance and a history of abnormal sensations in the left leg persisting for several months. His past medical history was unremarkable. Craniospinal magnetic resonance imaging showed an enhanced tumor in the pineal gland and widespread leptomeningeal dissemination in the spinal canal. Biopsy of the pineal tumor was performed. Histological examination revealed a pure germinoma. Chemotherapy with carboplatin and etoposide in combination with radiotherapy induced complete remission of the tumors. He regained normal eye movement and sensation in his left leg during the chemotherapy period. Germinomas with dissemination are generally more malignant and refractory than solitary germinomas, but this patient showed a strong response to chemoradiotherapy.
    Download PDF (313K)
  • —Case Report—
    Masato SHIBA, Masatoshi MURAMATSU, Katsuhiro TANAKA, Kotaro HORI, Seij ...
    Article type: Case Report
    2010 Volume 50 Issue 6 Pages 509-512
    Published: 2010
    Released on J-STAGE: June 25, 2010
    JOURNAL OPEN ACCESS
    A 35-year-old male showed slow progression of dilation of the lateral ventricles and third ventricle. He had undergone surgery for third ventricular colloid cyst and ventriculoperitoneal shunting when he was 3 years old. Computed tomography revealed progression of triventricular dilation. He underwent endoscopic fenestration of the arachnoid cyst and endoscopic third ventriculostomy. The postoperative course was good. Arachnoid cysts within the third ventricle are rare. Endoscopic treatment of an arachnoid cyst within the third ventricle is less invasive and effective for arachnoid cysts within the third ventricle associated with hydrocephalus.
    Download PDF (401K)
  • —Case Report—
    Hideo HAMADA, Nakamasa HAYASHI, Kimiko UMEMURA, Kunikazu KUROSAKI, Shu ...
    Article type: Case Report
    2010 Volume 50 Issue 6 Pages 512-514
    Published: 2010
    Released on J-STAGE: June 25, 2010
    JOURNAL OPEN ACCESS
    A 15-year-old boy presented with a case of middle cranial fossa arachnoid cyst associated with subdural effusion and manifesting as headache and vomiting after minor head injury. Computed tomography disclosed a cystic lesion in the left middle cranial fossa and ipsilateral subdural effusion. Fundoscopic examination revealed papilledema. A small tear of the cyst wall was confirmed endoscopically. Fenestration of the cyst was performed under the operating microscope. Postoperative course was uneventful. The tear in the outer wall of an arachnoid cyst may suggest the mechanism of occurrence of subdural effusion associated with middle cranial fossa arachnoid cyst.
    Download PDF (243K)
  • —Two Case Reports—
    Norihiko SAITO, Kazuya AOKI, Takatoshi SAKURAI, Keisuke ITO, Morito HA ...
    Article type: Case Report
    2010 Volume 50 Issue 6 Pages 515-517
    Published: 2010
    Released on J-STAGE: June 25, 2010
    JOURNAL OPEN ACCESS
    Two patients were treated for intracranial infections involving methicillin-resistant Staphylococcus aureus (MRSA). A 30-year-old woman was admitted to our hospital for intracerebral hemorrhage related to arteriovenous malformation. After decompressive craniectomy, the patient developed an epidural abscess. MRSA was isolated from the pus culture. The infection did not improve after intravenous vancomycin (VCM) administration for 15 days. However, after administration of linezolid (LZD) for 14 days, the infection had improved, and the white blood cell count and C-reactive protein values had normalized. A 53-year-old woman had previously undergone 3 operations for craniopharyngioma before the age of 35 years. She was admitted to our hospital with fever and disturbance of consciousness. Magnetic resonance imaging with contrast medium revealed a brain abscess caused by MRSA. After 14 days of intravenous administration of VCM, the infection had not improved and intravenous administration of LZD was initiated. After administration of LZD for 14 days intravenously and 14 days orally, the infection had improved, and the white blood cell count and C-reactive protein values had normalized. VCM is highly effective against MRSA infection, but penetration into the central nervous system (CNS) is poor. LZD has good CNS penetration, so should be considered for secondline antibiotic therapy for VCM-resistant intracranial MRSA infection.
    Download PDF (317K)
Technical Note
  • —Technical Note—
    Kentaro HORIGUCHI, Hisayuki MURAI, Yuzo HASEGAWA, Seiichiro MINE, Iwao ...
    Article type: Technical Note
    2010 Volume 50 Issue 6 Pages 518-522
    Published: 2010
    Released on J-STAGE: June 25, 2010
    JOURNAL OPEN ACCESS
    The endoscopic endonasal trans-sphenoidal approach can decompress the traumatized and swollen optic nerve without brain retraction. Three cases of traumatic optic neuropathy (TON) were treated by this endoscopic approach. We performed 58 endoscopic endonasal trans-sphenoidal approaches in 52 patients between April 2006 and December 2007. Three patients, 2 men and a woman aged 42-66 years, with TON were treated by endoscopic endonasal trans-sphenoidal optic nerve decompression. Adequate decompression of the optic canal was observed in all three patients. Two experienced improved visual function, but the third did not. No surgical complications were observed in any patient. We were able to reach the optic canal above the opticocarotid recess near the orbit. Endoscopic endonasal trans-sphenoidal optic canal decompression using a navigation system may be a safe and effective surgical strategy in carefully selected patients with TON.
    Download PDF (453K)
Editorial Committee
feedback
Top