Chikashi Maruki

Cardiac malignant fibrous histiocytoma metastasizing to the brain: Development of multiple neoplastic cerebral aneurysms

We report a case in which bilateral occipital brain metastases and neoplastic cerebral aneurysms developed from primary cardiac malignant fibrous histiocytoma. The origin of metastases was confirmed at autopsy. The clinical presentation, radiographic features, and autopsy findings are presented along with a histopathologic analysis of the tumor.

A case of giant expanding cephalhematoma: does the administration of blood coagulation factor XIII reverse symptoms?

BACKGROUND The mechanism of continuous massive hemorrhage into the subperiosteal space in children without coagulation defects is unknown. We report a case of giant expanding cephalhematoma reversed by the administration of blood coagulation factor XIII concentrate. METHOD The patient was an 8-year-old boy with a history of minor head trauma who developed a giant expanding cephalhematoma with intraorbital extension. The laboratory data showed severe anemia, but a routine blood coagulation test showed no abnormalities except for a low factor XIII level. RESULT The administration of factor XIII concentrate completely reversed the symptoms in 2 weeks. CONCLUSION We speculate that one of the possible mechanisms of cephalhematoma expansion without blood coagulation defects might be acquired factor XIII deficiency from severe hemorrhage in a hematoma.

Acoustic Neurinoma with Early Venous Drainage and Caput Medusae-like Vasculature on Angiogram

It has been considered that acoustic neurinomas are hypovascular tumors on angiogram. Recent angiographical analysis, however, revealed that some of them showed tumor stain, capsular stain, and even arteriovenous shunt. The problem with operation on the acoustic neurinoma with a peculiar vasculature on angiogram has not been discussed in previous reports. In this paper, the neuroradiological findings of a unique case are described, in conjunction with the operative problem. A case of huge acoustic neurinoma with early venous drainage and caput medusae-like vasculature on angiogram is presented. The patient was a 46-year-old woman suffering from dizziness and gait disturbance. On admission, she had bilateral choked disc, left fifth and seventh nerve palsy, and left cerebellar signs. The audiogram showed scale out on the left, carolic test and auditory brain stem response were nil on the left side. On computed tomography, a huge, heterogeneously enhanced mass was detected in the left cerebellopontine angle. Vertebral angiography revealed that the tumor was supplied by the anterior inferior cerebellar artery and ascending pharyngeal artery. Caput medusae-like vasculature was visualized in arterial and capillary phases, and abnormal draining veins were also opacified in these phases. They were considered to be an arteriovenous fistula. At operation, the abnormal vasculature looked like an arteriovenous malformation on the tumor capsule, which made the surgical procedure of dissecting the tumor from the pons extremely difficult.

Malignant Subdural Hematoma Associated with High-Grade Meningioma

A 70-year-old man, who had previously undergone surgical resection of left parasagittal meningioma involving the middle third of the superior sagittal sinus (SSS) two times, presented with recurrence of the tumor. We performed removal of the tumor combined with SSS resection as Simpson grade II. After tumor removal, since a left dominant bilateral chronic subdural hematoma (CSDH) appeared, it was treated by burr hole surgery. However, because the CSDH rapidly and repeatedly recurred and eventually changed to acute subdural hematoma, elimination of the hematoma with craniotomy was accomplished. The patient unfortunately died of worsening of general condition despite aggressive treatment. Histopathology of brain autopsy showed invasion of anaplastic meningioma cells spreading to the whole outer membrane of the subdural hematoma. Subdural hematoma is less commonly associated with meningioma. Our case indicates the possibility that subdural hematoma associated with meningioma is formed by a different mechanism from those reported previously.

Subarachnoid hemorrhage of unknown etiology at initial cerebral angiography: Clinical features of the unfavorable prognostic group

初回血管撮影で出血源が確定出来なかったくも膜下出血(SAHUE)例の臨床像について,自験例で検討した.1997.1～2005.6までに当院に入院した非外傷性SAH連続325例中,初回血管撮影で出血源が診断されなかった34例を対象.最終的に出血源不明で,再出血もきたさなかった15例をgroup A,出血源が判明した,或るいは再出血をきたした19例をgroup Bとして,その臨床像を比較検討した.Group Bはgroup Aに比べて,入院時症状・CT上の血腫量・症候性血管攣縮・水頭症の有無・最終的予後,のいずれについても重症度が高い傾向があきらかであった.最終的に出血源が判明したのは15例で,内頚動脈系と椎骨脳底動脈系が各6例と多かった.前者のうち,5例がいわゆる内頚動脈前壁動脈瘤(ICA)であった.SAHUEは,明らかな出血源がみられず予後良好な群は半数程度で,破裂動脈瘤の存在する通常のSAHも多く含まれている.中でも特に予後不良な転帰をとる例はICAの含まれている可能性が高く,注意を要する.