Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 51, Issue 11
Displaying 1-16 of 16 articles from this issue
Original Articles
  • Nobutake SADAMASA, Kazumichi YOSHIDA, Osamu NARUMI, Masaki CHIN, Sen Y ...
    Article type: Original Article
    2011 Volume 51 Issue 11 Pages 745-748
    Published: 2011
    Released on J-STAGE: November 25, 2011
    JOURNAL OPEN ACCESS
    This retrospective study investigated the correlations between red blood cell (RBC) count, hemoglobin, and hematocrit on admission, and mortality in 140 patients with subarachnoid hemorrhage (SAH). Correlations between the hematological parameters RBC count, hematocrit, hemoglobin, white blood cell (WBC) count, and platelet count on admission and mortality were investigated. Association of each variable with mortality was tested by univariate and multivariate logistic regression analysis. Univariate analysis showed that mortality was associated with RBC count, hematocrit, hemoglobin, and platelet count. Multivariate logistic regression analysis revealed hematocrit, WBC count, and platelet count were significant independent predictors for mortality after SAH. Hematocrit was a new significant predictor related to mortality in patients with SAH.
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  • Atsushi UMEMURA, Yuichi OKA, Kenichi YAMAMOTO, Kenji OKITA, Noriyuki M ...
    Article type: Original Article
    2011 Volume 51 Issue 11 Pages 749-755
    Published: 2011
    Released on J-STAGE: November 25, 2011
    JOURNAL OPEN ACCESS
    Subthalamic nucleus deep brain stimulation (STN-DBS) is effective for medically refractory Parkinson's disease. We retrospectively analyzed complications in 180 consecutive patients who underwent bilateral STN-DBS. Surgery-related complications were symptomatic intracerebral hemorrhage in 2, chronic subdural hematoma in 1, and transient deterioration of medication-induced psychosis in 2 patients. Device-related complications involved device infection in 5, skin erosion in 5, and implantable pulse generator malfunction in 2 patients. All of these patients required surgical repair. Surgery and device-related complications could be reduced with increased surgical experience and the introduction of new surgical equipment and technology. Treatment or stimulation-related complications were intractable dyskinesia/dystonia in 11, problematic dysarthria in 7, apraxia of eyelid opening (ALO) in 11, back pain in 10, and restless leg syndrome in 6 patients. Neuropsychiatric complications were transient mood changes in some, impulse control disorder in 2, severe depression related to excessive reduction of dopaminergic medications in 2, rapid progression of dementia in 1, and suicide attempts in 2 patients. Most complications were mild and transient. Dysarthria and ALO were the most frequent permanent sequelae after STN-DBS. Treatment-related adverse events may be caused not only by the effect of stimulation effect but also excessive reduction of dopaminergic medication, or progression of the disease. In conclusion, STN-DBS seems to be a relatively safe procedure. Although serious complications with permanent sequelae are rare, significant incidences of adverse effects occur. Physicians engaged in this treatment should have a comprehensive understanding of the probable complications and how to avoid them.
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  • Hiromichi YAMAMOTO, Naoya KUWAYAMA, Nakamasa HAYASHI, Michiya KUBO, Sh ...
    Article type: Original Article
    2011 Volume 51 Issue 11 Pages 756-761
    Published: 2011
    Released on J-STAGE: November 25, 2011
    JOURNAL OPEN ACCESS
    This study evaluated the usefulness of computed tomography (CT) angiography for the detection of high-risk aortas for carotid artery stenting (CAS). We investigated changes in the treatment method and modifications of endovascular techniques according to the information from CT angiography. CT angiography using three-dimensional and multi-planar reconstruction was performed in 43 consecutive patients with carotid artery stenoses intended to undergo CAS. Two neurosurgeons evaluated the images and estimated the risk and difficulties of CAS. CT angiography clearly depicted the entire aorta, the supra-aortic vessels, and the ilio-femoral arteries in all patients. Abnormal vascular findings were found in 17 patients. High-risk aortic lesions for CAS were detected in 5 patients, including thick aortic plaques with thrombi in 2. We changed the treatment strategy from CAS to carotid endarterectomy (CEA) in these 2 patients. CT angiograms proved very useful in evaluating the approach routes of CAS in 12 patients. One patient had dissecting aneurysm of the thoracic aorta and another had aberrant right vertebral artery. In these two, the treatment strategy was changed from CAS to CEA. The treatment method was changed in 4 patients in total. CT angiography is useful for the detection of high-risk aortas for CAS and for the evaluation of safe approaches to the carotid artery.
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  • Ken-ichi MORITA, Takatoshi SORIMACHI, Yasushi ITO, Kazuhiko NISHINO, Y ...
    Article type: Original Article
    2011 Volume 51 Issue 11 Pages 762-766
    Published: 2011
    Released on J-STAGE: November 25, 2011
    JOURNAL OPEN ACCESS
    This study evaluated the effectiveness of intra-aneurysmal coil embolization for large or giant carotid artery aneurysms in the cavernous sinus in seven patients treated by intra-aneurysmal coil embolization from 2001 to 2010. Only one patient showed improved neurological symptoms caused by aneurysmal mass effect during the mean follow-up period of 53.4 ± 27.3 months. Neurological symptoms caused by the aneurysms remained unchanged in two patients, and deteriorated in four. Intra-aneurysmal coil embolization is not considered an effective treatment option for large or giant carotid artery aneurysms in the cavernous sinus.
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  • Taku SUGIYAMA, Satoshi KURODA, Naoki NAKAYAMA, Shinya TANAKA, Kiyohiro ...
    Article type: Original Article
    2011 Volume 51 Issue 11 Pages 767-773
    Published: 2011
    Released on J-STAGE: November 25, 2011
    JOURNAL OPEN ACCESS
    The mechanisms through which moyamoya disease occurs and progresses remain unknown. Recent studies have indicated the involvement of circulating endothelial progenitor cells (EPCs) in the development of moyamoya disease. This study directly investigated the participation of EPCs in moyamoya disease, using specimens of the supraclinoid internal carotid artery collected from two adult patients. The specimens were stained with primary antibodies against CD34, CD133, and vascular endothelial growth factor receptor-2 (VEGFR2) to localize the circulating EPCs in the thickened intima of occlusive arterial lesion. The CD34- and VEGFR2-positive cells were densely found in the thickened intima of occlusive arterial lesion, particularly clustered in the superficial layer of thickened intima. However, the number of CD34- and CD133-positive cells was very small. The CD34-positive cells also expressed von Willebrand factor on the surface of thickened intima and were also positive for α-smooth muscle actin in the deeper layer. These findings suggest that circulating EPCs may be involved in the development of occlusive arterial lesion in moyamoya disease.
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Case Reports
  • —Three Case Reports—
    Yoshikazu ARAI, Ken MATSUDA, Makoto ISOZAKI, Tsuyoshi NAKAJIMA, Ken-ic ...
    Article type: Case Report
    2011 Volume 51 Issue 11 Pages 774-776
    Published: 2011
    Released on J-STAGE: November 25, 2011
    JOURNAL OPEN ACCESS
    Three cases of ruptured intracranial aneurysm associated with moyamoya disease are presented. Endovascular treatments were performed successfully in two patients with major artery aneurysms. One patient with a collateral aneurysm was managed conservatively and follow-up angiography 1 year later demonstrated spontaneous disappearance of the aneurysm. Our experience suggests that although aneurysms associated with moyamoya disease show differences in evolution and location, endovascular treatment of major artery aneurysms is safe and effective, and peripheral aneurysms which cannot be directly accessed for surgery or endovascular embolization may be treated conservatively.
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  • —Case Report—
    Katsuya UMEOKA, Kazutaka SHIROKANE, Takayuki MIZUNARI, Shiro KOBAYASHI ...
    Article type: Case Report
    2011 Volume 51 Issue 11 Pages 777-780
    Published: 2011
    Released on J-STAGE: November 25, 2011
    JOURNAL OPEN ACCESS
    A 65-year-old woman presented a rare dissecting aneurysm of the anterior temporal artery (ATA) manifesting as headache. Computed tomography and magnetic resonance imaging revealed a mixed-density mass in the horizontal segment of the middle cerebral artery. Emergent angiography demonstrated aneurysmal dilatation and a thrombosed mass in the sylvian fissure. Infectious aneurysm was excluded. She underwent emergent surgery to reduce the risk of repeated infarction and hemorrhage. The distal side of the ATA manifested occlusive changes suggestive of arterial dissection. The proximal side of the ATA was ligated and the lesion was excised. Histological examination confirmed that the aneurysmal dilatation was attributable to arterial dissection due to disruption of the internal elastic lamina. Distal dissecting aneurysms may occur in the absence of infectious disease. We recommend that ruptured distal dissecting aneurysms be treated surgically in the acute stage immediately after detection.
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  • —Case Report—
    Naoto SAKAI, Soichi AKAMINE, Tsutomu TOKUYAMA, Kenji SUGIYAMA, Naohiro ...
    Article type: Case Report
    2011 Volume 51 Issue 11 Pages 780-783
    Published: 2011
    Released on J-STAGE: November 25, 2011
    JOURNAL OPEN ACCESS
    A 37-year-old woman with congenital afibrinogenemia presented with chronic subdural hematoma (CSDH) manifesting as severe headache, nausea, and somnolence after a minor head trauma. Brain computed tomography scans showed a right subdural hematoma associated with midline shift. Laboratory studies showed prolongation of prothrombin time, activated partial thromboplastin time, and undetectably low level of fibrinogen. Until the present episode, she had received plasma-derived fibrinogen concentrate around menstruation and pregnancy. She had also suffered from spinal cord infarction due to vertebral artery occlusion. Burr-hole evacuation and drainage of CSDH was successfully performed using fibrinogen concentrate. The development of CSDH with afibrinogenemia is very rare. Although the past repeated administrations of fibrinogen concentrate were suspected to generate CSDH, paradoxical thrombotic complications caused by upregulation of prothrombin activation, thrombin generation, and growth factors released from platelets might be related to the development of CSDH with congenital afibrinogenemia.
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  • —Case Report—
    Hidehiro OKURA, Kenji YATOMI, Youhei SAITO, Chinatsu KASUGA, Hisato IS ...
    Article type: Case Report
    2011 Volume 51 Issue 11 Pages 784-788
    Published: 2011
    Released on J-STAGE: November 25, 2011
    JOURNAL OPEN ACCESS
    A 2-year-old girl who had previously been treated for stage IV intra-abdominal neuroblastoma presented with headache and vomiting. Computed tomography (CT) showed hematoma in the right temporal lobe. Two months previously, she had suffered a generalized seizure but brain CT was unremarkable. The hematoma was removed completely without evidence of vascular anomaly or tumor. Four weeks after surgery, magnetic resonance imaging with gadolinium showed a developing mass lesion in the hematoma bed. A second operation for tumor removal confirmed the rare diagnosis of intraparenchymal metastasis. Metastatic neuroblastoma to the central nervous system (CNS) occasionally can cause massive hemorrhage. Therefore, early detection of CNS metastasis can be important. The related factors in this patient with abdominal neuroblastoma included elevated serum lactate dehydrogenase, N-myc gene amplification, and coexisting orbital metastasis, which all occurred within 22 months from initial diagnosis. The median interval from diagnosis of the primary tumor to diagnosis of CNS metastasis in neuroblastoma is 12-22 months, which indicates relatively late metastasis presentation. The initial presentation of this late metastasis is hemorrhage that can have sudden detrimental consequences, so a patient with neuroblastoma must be followed up carefully, particularly if elevated serum lactate dehydrogenase, orbital metastasis, N-myc gene amplification, or clinical symptoms are present, even if brain CT is unremarkable. The understanding that intraparenchymal hematoma can occur prior to detectable CNS metastasis may be important for early detection of this life-threatening condition.
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  • —Case Report—
    Shigeru YAMAGUCHI, Shunsuke TERASAKA, Hiroyuki KOBAYASHI, Katsuyuki AS ...
    Article type: Case Report
    2011 Volume 51 Issue 11 Pages 789-792
    Published: 2011
    Released on J-STAGE: November 25, 2011
    JOURNAL OPEN ACCESS
    A 43-year-old female presented with a giant skull base atypical meningioma manifesting as rapid progression of impaired consciousness. The meningioma was located in the ethmoid sinus, sphenoid sinus, nasal cavity, and left middle temporal fossa, and the intracranial portion of the tumor involved the left temporal region with massive surrounding brain edema in the left temporal lobe and basal ganglia. She underwent emergent fronto-temporo-parietal decompressive craniectomy, and the intracranial portion of the tumor was resected to control intracranial pressure. She recovered consciousness and neurological function dramatically, and subsequently underwent radical tumor resection via combined extended transbasal and left lateral transzygomatic infratemporal fossa approaches one month after the initial surgery. The extensive brain edema completely disappeared after tumor resection, and the patient fully recovered without neurological deficits except anosmia and small visual field defect. Rapid neurological deterioration and disturbance of consciousness caused by extensive peritumoral brain swelling are unusual in meningioma. In this case, the extemporaneous decompressive craniectomy was highly useful in the management of increased intracranial pressure.
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  • —Case Report—
    Daisuke SHIMBO, Tsutomu KATO, Makoto TAKEDA, Hitoshi IKEDA
    Article type: Case Report
    2011 Volume 51 Issue 11 Pages 793-797
    Published: 2011
    Released on J-STAGE: November 25, 2011
    JOURNAL OPEN ACCESS
    A 10-year-old boy presented with an intraparenchymal meningioma, which had no attachment to the dura, manifesting as grand-mal seizure. Neurological examination showed no abnormalities. Magnetic resonance (MR) imaging revealed a round, well demarcated mass in the left frontal lobe, which was homogeneously enhanced. The tumor appeared to be intraaxial and caused marked peritumoral white matter edema. At operation, the mass was totally embedded in the frontal lobe and gross total resection was accomplished. The histological diagnosis was meningothelial meningioma with chordoid components in World Health Organization grade I. His postoperative course was uneventful and postoperative MR imaging revealed no residual tumor. Intraparenchymal meningioma should be considered in the differential diagnosis of an intraaxial lesion in a child.
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  • —Case Report—
    Yuuta KAMOSHIMA, Yutaka SAWAMURA, Tetsuaki IMAI, Hiroshi FURUKAWA, Kan ...
    Article type: Case Report
    2011 Volume 51 Issue 11 Pages 798-800
    Published: 2011
    Released on J-STAGE: November 25, 2011
    JOURNAL OPEN ACCESS
    A 2-year-old female presented with a rare case of recurrent giant cell tumor affecting the frontal bone. She had already undergone partial removal twice at the ages of 14 and 18 months. The tumor was located in the frontal bone, expanding to the ethmoid and orbital bones, and invading the frontal base dura mater. The tumor was totally removed including the surrounding bone and frontal base dura mater. No local recurrence and metastasis were observed at 18 months after the last operation. Most giant cell tumors occur in the epiphyses of long bones and are rare in the cranio-facial bone. These tumors usually affect young adults and few pediatric cases are reported.
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  • —Case Report—
    Go TAKEISHI, Kouichi MOROKI, Takuma KAWASOE, Tsuyoshi FUKUSHIMA, Kiyot ...
    Article type: Case Report
    2011 Volume 51 Issue 11 Pages 801-804
    Published: 2011
    Released on J-STAGE: November 25, 2011
    JOURNAL OPEN ACCESS
    A 74-year-old woman presented with central nervous system (CNS) lymphomatoid granulomatosis (LYG) that spontaneously regressed and then regrew shortly thereafter. Initial magnetic resonance imaging studies showed a well demarcated, round, enhanced lesion with perifocal edema in the left temporal lobe. The enhanced lesion and perifocal edema had drastically regressed without treatment at follow-up examination. Two months later, the lesion reappeared and was larger, so was completely removed via left fronto-temporal craniotomy. The histological diagnosis was CNS LYG. CNS LYG should be considered in the differential diagnosis of spontaneously regressing brain tumors.
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  • —Case Report—
    Tohru TERAO, Takuya ISHII, Satoshi TANI, Toshiaki ABE
    Article type: Case Report
    2011 Volume 51 Issue 11 Pages 805-809
    Published: 2011
    Released on J-STAGE: November 25, 2011
    JOURNAL OPEN ACCESS
    An 81-year-old woman with failed back surgery syndrome (FBSS) was treated using a combination of percutaneous radiofrequency (RF) lumbar zygapophysial joint denervation and epidural spinal cord stimulation (SCS). She had undergone a staged laminectomy for narrowing of the spinal canal from L1 to S1 and degenerative spondylolisthesis at the L3-4 level. Postoperatively, in addition to low back pain (LBP) induced by dynamic motion, she began to experience intractable leg pain with a burning sensation, presumably caused by damage to the cauda equina. She initially underwent RF lumbar zygapophysial joint denervation for the LBP and subsequently underwent SCS via dual electrode leads for the leg pain. This combination therapy of RF denervation and SCS relieved the LBP almost entirely and relieved the leg pain by approximately 50%. The combination of these two minimally invasive interventions is particularly effective for severe leg pain and LBP in elderly patients or medically compromised cases with contraindications against general anesthesia, as well as in patients with FBSS.
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  • —Case Report—
    Yasuhiro TAKESHIMA, Toshiyuki TAKAHASHI, Junya HANAKITA, Mizuki WATANA ...
    Article type: Case Report
    2011 Volume 51 Issue 11 Pages 809-811
    Published: 2011
    Released on J-STAGE: November 25, 2011
    JOURNAL OPEN ACCESS
    A 39-year-old man presented with an extremely rare discal cyst at the L3-4 level manifesting as a left L4 radiculopathy. Two months after onset, he suffered right L4 radiculopathy with new lumbar disc protrusion. Five months after medical treatment, the patient's symptoms improved, and the discal cyst showed complete regression on magnetic resonance imaging. Most cases of discal cyst are surgically treated, with only two previous cases of spontaneous regression. The present case suggests clinical and radiological recovery of symptomatic lumbar discal cyst can be obtained by only conservative therapy.
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