Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 54, Issue 5
Displaying 1-14 of 14 articles from this issue
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Original Articles
  • Primary Enlarged Craniotomy in Organized Chronic Subdural Hematomas
    Giorgio Maria CALLOVINI, Andrea BOLOGNINI, Gemma CALLOVINI, Vincenzo G ...
    2014 Volume 54 Issue 5 Pages 349-356
    Published: 2014
    Released on J-STAGE: May 15, 2014
    Advance online publication: December 05, 2013
    DOIhttps://doi.org/10.2176/nmc.oa2013-0099
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    The aim of the study is to evaluate the efficacy of craniotomy and membranectomy as initial treatment of organized chronic subdural hematoma (OCSH). We retrospectively reviewed a series of 34 consecutive patients suffering from OCSH, diagnosed by magnetic resonance imaging (MRI) or contrast computer tomography (CCT) in order to establish the degree of organization and determine the intrahematomal architecture. The indication to perform a primary enlarged craniotomy as initial treatment for non-liquefied chronic subdural hematoma (CSDH) with multilayer loculations was based on the hematoma MRI appearance—mostly hyperintense in both T1- and T2-weighted images with a hypointense web- or net-like structure within the hematoma cavity. The reason why some hematomas evolve towards a complex and organized architecture remains unclear; the most common aspect to come to light was the “long standing” of the CSDHs which, in our series, had an average interval of 10 weeks between head injury and initial scan. Recurrence was found to have occurred in 2 patients (6% of cases) in the form of acute subdural hematoma. One patient died as the result of an intraventricular and subarachnoid haemorrhage, while 2 patients (6%) suffered an haemorrhagic stroke ipsilateral to the OCSH. Eighty-nine percent of cases had a good recovery, while 11% remained unchanged or worsened. In select cases, based on the MRI appearance, primary enlarged craniotomy seems to be the treatment of choice for achieving a complete recovery and a reduced recurrence rate in OCSH.
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  • Expression of the TGF-β–ALK-1 Pathway in Dura and the Outer Membrane of Chronic Subdural Hematomas
    Atsushi SAITO, Ayumi NARISAWA, Hiroki TAKASAWA, Takahiro MORITA, Seiya ...
    2014 Volume 54 Issue 5 Pages 357-362
    Published: 2014
    Released on J-STAGE: May 15, 2014
    Advance online publication: December 05, 2013
    DOIhttps://doi.org/10.2176/nmc.oa2013-0019
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    Neovascularization of the outer membrane plays a critical role in the development and enlargement of chronic subdural hematomas (CSHs) and vascular endothelial growth factor (VEGF) may promote their progression. However, the precise mechanisms remain to be determined. We focused on the signaling pathway upstream of VEGF, transforming growth factor β (TGF-β), and activin receptor-like kinase 1 (ALK-1) to identify the mechanisms underlying the neovascularization of the outer membrane of CSH. Retrospective comparative study was conducted on 15 consecutive patients diagnosed as CSH with burr-hole drainage. Dura and the outer membrane were collected. We immunohistochemically examined the expression of VEGF, integrin-α, TGF-β, and ALK-1 on the outer membrane and dura of CSH and compared our findings with control samples and the signal intensity of hematomas on computed tomography (CT) scans. VEGF and integrin-α expression was markedly up-regulated in both the dura and outer membrane of CSH, the expression of TGF-β and ALK-1 in the dura was slightly increased in the dura and markedly up-regulated in the outer membrane. There was no significant correlation between their expression and CT density. Here we first report the expression of TGF-β and ALK-1 in the outer membrane and dura mater of CSH. We suggest that the TGF-β–ALK-1 pathway and VEGF affect neovascularization and the progression of CSH.
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  • Effect of Inner Membrane Tearing in the Treatment of Adult Chronic Subdural Hematoma: A Comparative Study
    Selim KAYACI, Ayhan KANAT, Vaner KOKSAL, Bulent OZDEMIR
    2014 Volume 54 Issue 5 Pages 363-373
    Published: 2014
    Released on J-STAGE: May 15, 2014
    Advance online publication: January 28, 2014
    DOIhttps://doi.org/10.2176/nmc.oa.2013-0147
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    The postoperative results of chronic subdural hematoma (CSDH) procedures using catheterization and tearing of inner membrane (CTIM) technique have not previously been discussed in the literature. This article compares the effects of CTIM technique on brain re-expansion and re-accumulation with cases operated on with a burr-hole craniotomy and outer membrane incision (BCOMI) technique. The study involved operations on 144 patients (Group 1) using the CTIM technique and 108 patients (Group 2) using the BCOMI technique. In the operations using the CTIM technique in Group 1, the mean effusion measured in the subdural space (SDS) was 10.0 ± 0.2 mm, and for Group 2, 14.3 ± 0.6 mm in the postoperative period on the first and third days and this difference was found to be significant (p < 0.05). The means were 6.6 ± 0.2 mm for Group 1 and 10.3 ± 0.5 mm for Group 2 on the seventh day (p < 0.05). Recurrence rate was 8.3% in Group 2 and 0 in Group 1. This difference was statistically significant (p = 0001). The length of hospital stay was 7.0 ± 0.1 days for the Group 1 and 8.8 ± 0.2 days for Group 2 and this difference was significant (p < 0.05). These results indicate that the CTIM technique is preferable because it results in earlier re-expansion, lower recurrence, less subdural effusion and pneumocephalus, and shorter hospital stays.
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  • Rotational Acceleration during Head Impact Resulting from Different Judo Throwing Techniques
    Haruo MURAYAMA, Masahito HITOSUGI, Yasuki MOTOZAWA, Masahiro OGINO, Ka ...
    2014 Volume 54 Issue 5 Pages 374-378
    Published: 2014
    Released on J-STAGE: May 15, 2014
    Advance online publication: January 28, 2014
    DOIhttps://doi.org/10.2176/nmc.oa.2013-0227
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    Most severe head injuries in judo are reported as acute subdural hematoma. It is thus necessary to examine the rotational acceleration of the head to clarify the mechanism of head injuries. We determined the rotational acceleration of the head when the subject is thrown by judo techniques. One Japanese male judo expert threw an anthropomorphic test device using two throwing techniques, Osoto-gari and Ouchi-gari. Rotational and translational head accelerations were measured with and without an under-mat. For Osoto-gari, peak resultant rotational acceleration ranged from 4,284.2 rad/s2 to 5,525.9 rad/s2 and peak resultant translational acceleration ranged from 64.3 g to 87.2 g; for Ouchi-gari, the accelerations respectively ranged from 1,708.0 rad/s2 to 2,104.1 rad/s2 and from 120.2 g to 149.4 g. The resultant rotational acceleration did not decrease with installation of an under-mat for both Ouchi-gari and Osoto-gari. We found that head contact with the tatami could result in the peak values of translational and rotational accelerations, respectively. In general, because kinematics of the body strongly affects translational and rotational accelerations of the head, both accelerations should be measured to analyze the underlying mechanism of head injury. As a primary preventative measure, throwing techniques should be restricted to participants demonstrating ability in ukemi techniques to avoid head contact with the tatami.
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  • Factors Associated with Blunt Cerebrovascular Injury in Patients with Cervical Spine Injury
    Hiroyuki NAKAJIMA, Manabu NEMOTO, Tetsuya TORIO, Ririko TAKEDA, Hideto ...
    2014 Volume 54 Issue 5 Pages 379-386
    Published: 2014
    Released on J-STAGE: May 15, 2014
    Advance online publication: December 27, 2023
    DOIhttps://doi.org/10.2176/nmc.oa.2013-0135
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    Blunt cerebrovascular injury (BCVI) is known to be a potentially fatal complication of cervical spine injury (CSI). Methods for screening the appropriate population remain to be elucidated, especially in Japan. This retrospective study was conducted to predict the risk factors relevant to BCVIs. Among 92 patients with CSI transferred to our institution from April 2007 to March 2012, 40 patients (35 men, 5 women) with neurological deficits and/or significant cervical spine fracture including fracture of transversarium, facet, body, lamina, and spinous process, underwent multi-detector computed tomography angiography (MDCTA) and magnetic resonance angiography (MRA), which identified 10 patients with BCVI [2 carotid artery injuries (BCAIs) and 9 vertebral artery injuries (BVAIs); 1 patient suffered both]. Univariate analyses exploring associations between individual risk factors and BCVI and BVAI were performed using Fisher’s exact test and Chi-square test for dichotomous variables and the unpaired t-test for continuous variables. Multiple logistic regression analyses for BCVI and BVAI were carried out using stepwise methods. On univariate and multivariate analysis, hyperextension injury was significantly associated with BVAI (p = 0.01 and p = 0.02), and subluxation (dislocation of vertebral body > 5 mm) was a significant predictor of BCVI (p = 0.04 and p = 0.03) and BVAI (p = 0.01 and p = 0.01). Prompt evaluation for BCVIs is recommended in CSI patients with hyperextension injury and dislocation of the vertebral body.
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  • The Neuroprotective Effect of Treatment with Curcumin in Acute Spinal Cord Injury: Laboratory Investigation
    Kyoung-Tae KIM, Myoung-Jin KIM, Dae-Chul CHO, Seong-Hyun PARK, Jeong-H ...
    2014 Volume 54 Issue 5 Pages 387-394
    Published: 2014
    Released on J-STAGE: May 15, 2014
    Advance online publication: January 28, 2014
    DOIhttps://doi.org/10.2176/nmc.oa.2013-0251
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    The purpose of this study was investigating the effects of curcumin on the histological changes and functional recovery following spinal cord injury (SCI) in a rat model. Following either sham operation or SCI, 36 male Sprague–Dawley rats were distributed into three groups: sham group, curcumin-treated group, and vehicle-injected group. Locomotor function was assessed according to the Basso, Beattie, and Bresnahan (BBB) scale in rats who had received daily intraperitoneal injections of 200 mg/kg curcumin or an equivalent volume of vehicle for 7 days following SCI. The injured spinal cord was then examined histologically, including quantification of cavitation. BBB scores were significantly higher in rats receiving curcumin than receiving vehicle (P < 0.05). The cavity volume was significantly reduced in the curcumin group as compared to the control group (P = 0.039). Superoxide dismutase (SOD) activity was significantly elevated in the curcumin group as compared to the vehicle group but was not significantly different from the sham group (P < 0.05, P > 0.05, respectively) at one and two weeks after SCI. Malondialdehyde (MDA) levels were significantly elevated in the vehicle group as compared to the sham group (P < 0.05 at 1 and 2 weeks). MDA activity was significantly reduced in the curcumin group at 2 weeks after SCI when compared to the vehicle group (P = 0.004). The numbers of macrophage were significantly decreased in the curcumin group (P = 0.001). This study demonstrated that curcumin enhances early functional recovery after SCI by diminishing cavitation volume, anti-inflammatory reactions, and antioxidant activity.
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  • Relationship of Age, Body Mass Index, Wrist and Waist Circumferences to Carpal Tunnel Syndrome Severity
    Hatice Ferhan KOMURCU, Selim KILIC, Omer ANLAR
    2014 Volume 54 Issue 5 Pages 395-400
    Published: 2014
    Released on J-STAGE: May 15, 2014
    Advance online publication: November 20, 2013
    DOIhttps://doi.org/10.2176/nmc.oa2013-0028
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    Carpal tunnel syndrome (CTS) has a multifactorial etiology involving systemic, anatomical, idiopathic, and ergonomic characteristics. In this study, an investigation of the relationship between the CTS degree established by electrophysiological measurements in patients with clinical CTS prediagnosis, and age, gender, body mass index (BMI), hand wrist circumference, and waist circumference measurements has been done. On 547 patients included in the study, motor and sensory conduction examinations of the median and ulnar nerve were done on one or two upper extremities thought to have CTS. In terms of CTS severity, the patients were divided into four groups (normal, mild, medium, and severe CTS). A total of 843 electrophysiological examinations were done consisting of 424 on the right hand wrist and 419 on the left hand wrist. When the age group of 18–35 years is taken as the reference group, the CTS development risk independent of BMI has been found to have increased by a factor of 1.86 for ages 36–64 years, and by 4.17 for ages 65 years and higher after adjustment for BMI. With respect to normal degree CTS group, the BMI were significantly different in groups with mild, medium, and severe CTS. The waist circumferences of groups with mild, medium, and severe CTS severity were found to be significantly higher in comparison to the normal reference group. When this value was corrected with BMI and re-examined the statistically significant differences persisted. The study identified a significant relationship between the CTS severity and age, BMI, waist circumference.
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Case Reports
  • Chronic Subdural Hematoma in Elderly Patient with EDTA-dependent Pseudothrombocytopenia Recently Treated with Aspirin and Warfarin: Case Report
    Masato TOSA, Hiroshi FUJITA, Yumiko ISHIHAMA, Shigeko NISHIMURA, Takaf ...
    2014 Volume 54 Issue 5 Pages 401-404
    Published: 2014
    Released on J-STAGE: May 15, 2014
    Advance online publication: January 28, 2014
    DOIhttps://doi.org/10.2176/nmc.cr.2013-0263
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    A 78-year-old man who had a history of myocardial and cerebral infarction and who was treated with aspirin and warfarin, presented with left chronic subdural hematoma. Cerebral computed tomography showed severe brain compression of hematoma with midline shift, indicating the need for emergent surgery. The hematology and clotting tests upon admission revealed severe thrombocytopenia (platelet count, 1.3 × 104/μL) with normal clotting activity. Because platelet aggregation was evident in the smear, we re-examined the patient for hematology using tubes that contained heparin, showing also low platelet count (2.3 × 104/μL). The day on admission, we performed irrigation and drainage of the chronic subdural hematoma through single burr-hole craniostomy. During surgery, we used 10 units of platelet concentrates (PCs) for the reason that the patient was taking aspirin and coagulopathy derived from low platelet count could not be excluded. After surgery, we re-evaluated the hematology of the blood stored in tubes that contained ethylenediaminetetraacetic acid (EDTA) with or without kanamycin (KM). Treatment with KM dissociated EDTA-induced platelet aggregation and revealed platelet counts with highest accuracy (no KM treatment, 1.3 × 104/μL; KM treatment, 15.2 × 104/μL). This phenomenon is called EDTA-Dependent Pseudothrombocytopenia (PTCP) defined as falsely low platelet counts reported by automated hematology analyzers due to platelet aggretgation. Awareness of the phenomenon will enable neurosurgeons to manage patients with PTCP appropriately and clinical laboratory especially in emergency hospital is recommended to prepare for the hematological tubes being added KM in routine analysis, resulting in preventing mistaken diagnosis.
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  • Pneumocephalus and Pneumorrhachis after Spinal Surgery: Case Report and Review of the Literature
    Ergun KARAVELIOGLU, Olcay ESER, Alpay HAKTANIR
    2014 Volume 54 Issue 5 Pages 405-407
    Published: 2014
    Released on J-STAGE: May 15, 2014
    Advance online publication: December 05, 2013
    DOIhttps://doi.org/10.2176/nmc.cr2013-0118
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    Trauma is a common cause of pneumocephalus, or air in the cranial cavity, and of pneumorrhachis, or the presence of intraspinal air. After spinal surgery, occurrence of pneumocephalus, especially with pneumorrhachis, is extremely rare. We report the case of a patient who developed pneumocephalus and pneumorrhachis after lumbar disc surgery and pedicle screw fixation. There was no cerebrospinal fluid leakage during surgery. On postoperative day 1, the patient complained of headache, nausea, and dizziness. Brain and lumbar computed tomography scans revealed pneumocephalus and pneumorrhachis. With conservative treatment, the patient’s complaints resolved within 10 days.
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  • Symptomatic Osteochondroma of Lumbosacral Spine: Report of 5 Cases
    Keita KURAISHI, Junya HANAKITA, Toshiyuki TAKAHASHI, Mizuki WATANABE, ...
    2014 Volume 54 Issue 5 Pages 408-412
    Published: 2014
    Released on J-STAGE: May 15, 2014
    Advance online publication: October 29, 2013
    DOIhttps://doi.org/10.2176/nmc.cr2012-0049
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    We describe 5 cases of osteochondroma (OC) originating from lumbosacral spine which caused radiculopathy. Four cases originated from the lumbar spine; all from L4 inferior articular process and presented L5 radiculopathy, the other one case originated from the sacrum; the case from S1 superior articular process presented L5 radiculopathy. In all cases, definitive diagnosis was made with histopathological findings; typical cartilaginous capping was confirmed. The functional recovery was completed in all 5 cases. As for imaging study, post myelography computed tomography revealed the most diagnostic tool for understanding the relationship between nerve tissue and the tumor. In all 5 patients, the tumors contained a high signal intensity on T2-weighted images in the cental medullary area. OCs are sometimes difficult to diagnose because they mimic other conditions like bony spur formation due to osteoarthritis, so we should never fail to confirm the histopathological diagnosis of such lesions when suspected.
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  • Atlanto Axial Rotatory Dislocation in Adults: A Rare Complication of an Epileptic Seizure—Case Report
    Roberto TARANTINO, Pasquale DONNARUMMA, Nicola MAROTTA, Paolo MISSORI, ...
    2014 Volume 54 Issue 5 Pages 413-416
    Published: 2014
    Released on J-STAGE: May 15, 2014
    Advance online publication: November 08, 2013
    DOIhttps://doi.org/10.2176/nmc.cr2012-0431
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    Atlanto Axial Rotatory Dislocations (AARDs) are a heterogeneous group of post-traumatic pathologies typical of the pediatric age, and rare in adults. We describe the case of a 34-year-old woman, developing Atlanto Axial Rotatory Fixation (AARF) after a generalized tonic-clonic epileptic seizure, an extremely rare traumatic cause never described in literature. AARF was detected only 1 month after the accident and nonsurgical treatment was attempted at the beginning. The patient underwent surgery only 2 months after the accident. The best treatment should be conservative reduction within 1 month; when it is not possible, it is advisable to perform surgery as soon as possible. C1–C2 fixation with Harm’s technique is the gold standard for fixed luxations. Delay of treatment makes intraoperative reduction more difficult and increase the establishment of the chronic permanent change of neck muscles and ligaments.
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  • Primary Spinal Neurocytoma Involving the Medulla Oblongata: Two Case Reports and a Literature Review
    Liang WU, Xiaofeng DENG, Chenlong YANG, Lei ZHAO, Tao YANG, Yulun XU
    2014 Volume 54 Issue 5 Pages 417-422
    Published: 2014
    Released on J-STAGE: May 15, 2014
    Advance online publication: November 20, 2013
    DOIhttps://doi.org/10.2176/nmc.cr2012-0345
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    Central neurocytoma is a rare neuroectodermal tumor found in young adults. These tumors are generally located in the lateral or third ventricles. Extraventricular neurocytoma in the spinal cord is extremely rare. We report on two patients with primary spinal neurocytomas who presented with progressive numbness and weakness in the limbs. Both patients had intramedullary masses between the medulla and the upper thoracic levels. The clinical, radiological, surgical, and pathological features of this abnormality are discussed, and all 20 reported cases were reviewed. In conclusion, neurocytoma should be included in the differential diagnosis of a spinal intramedullary tumor, and subtotal resection is acceptable for a relatively favorable prognosis if gross total removal is unachievable. The efficacy of adjuvant radiochemotherapy to control tumor recurrence is unknown.
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  • Normal Pressure Hydrocephalus Caused by a Spinal Neurinoma at the Cauda Equina Level: A Case Report
    Daisuke WAJIMA, Yuki IDA, Takuo INUI, Hiroyuki NAKASE
    2014 Volume 54 Issue 5 Pages 423-427
    Published: 2014
    Released on J-STAGE: May 15, 2014
    Advance online publication: November 20, 2013
    DOIhttps://doi.org/10.2176/nmc.cr2012-0365
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    Neurinomas are common space-occupying lesions located in the spinal canal. Many reports concerning their clinical characteristics, diagnoses, treatments, and operative results have been published. Some case reports have discussed spinal neurinomas located at the cauda equina level. However, there is little information on their natural history. Here, we report a case of spinal neurinoma located at the cauda equina level, which caused normal pressure hydrocephalus (NPH). All symptoms resulting from the NPH were resolved by tumor removal. These findings suggested that if a spinal neurinoma located at the cauda equina level causes symptoms due to NPH, then removal of the tumor should be considered, when appropriate removal procedures are possible.
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