Haruo Takamura

Severe stenosis of the internal carotid artery presenting as loss of consciousness due to the presence of a primitive hypoglossal artery: a case report

BACKGROUND Symptoms of ischemic attacks in the internal carotid system usually involve focal cerebral dysfunction, i.e., hemiparesis or aphasia. However, an ischemic attack in the vertebrobasilar artery system usually presents with combined symptoms. The variety of manifestations included in the vertebrobasilar profile makes the potential pattern of symptoms considerably more variable and complex than that in the carotid system. Manifestations can include syncope and also vertigo. METHOD AND RESULTS A 42-year-old woman experienced frequent attacks of faintness with vertigo. Angiography demonstrated severe stenosis of the left internal carotid artery with a persistent primitive hypoglossal artery just distal to the stenosis. The right internal carotid artery was normal and cross circulation through the anterior communicating artery was not well developed. Both vertebral arteries were hypoplastic. The patient underwent carotid endarterectomy and, thereafter the episodes of syncope completely disappeared. CONCLUSION It was supposed that global ischemia including the brain stem occurred because of stenosis of the left internal carotid artery attributable to the presence of a primitive hypoglossal artery.

Congenital Anaplastic Ependymoma: A Case Report of Familial Glioma

A congenital anaplastic infratentorial ependymoma, occurring in a female infant whose sister also died of brain tumor, is described. The tumor, located in the cerebellum and the fourth ventricle, is characterized by predominantly undifferentiated neuroepithelial cells associated with numerous mitoses, and partially of the cells demonstrating differentiation into ependymal cells and astrocytes. Of special interest is the fact that the elder sister of the patient had also died of a congenital glioma located in the cerebellum and the fourth ventricle, which leads to the discussion about the influences of genetic factors in the development of the familial gliomas as well as about the histogenesis of the tumor examined.

Assessment of outcome by EC/IC bypass with123I-iomazenil brain SPECT

We report two patients with occlusive cerebrovascular disease who were examined by means of benzodiazepine receptor SPECT(BZR-SPECT) with123I-iomazenil (IMZ) before extracranial-intracranial bypass surgery (EC/IC bypass). Preoperative low perfusion areas detected by cerebral blood flow SPECT (CBF-SPECT) were divided into two parts on BZR-SPECT images. In the low perfusion areas where the BZR were preserved, regional cerebral blood flow (rCBF) increased on postoperative CBF-SPECT, but where the BZR were not preserved, rCBF did not increase on postoperative CBF-SPECT. On visual inspection, the SPECT images of postoperative CBF-SPECT appeared similar to those of preoperative BZR-SPECT. For evaluation of the ischemic brain condition itself, instead of the cerebral metabolism, the distribution and activity of cerebral neurons indicated by BZR-SPECT with IMZ might be utilized.

Infra-optic course of the anterior cerebral artery.

This report describes the infra-optic course of an anterior cerebral artery in a 67-year-old man. An aneurysm was also incidentally detected at the anterior communicating artery. Thirty-three cases have been published previously and the literature concerning this anomaly is reviewed.

An Operated Case of Thrombosed Giant Middle Cerebral Artery Aneurysm

A 70-year-old woman visited our hospital with complaints of right hemiparesis and motor aphasia. Neuroradiological studies revealed a giant and partially thrombosed aneurysm at the trifurcation of the left middle cerebral artery (MCA). She wastreated by total resection of the aneurysm and arterial transposition following double STA-MCA anastomoses. Perforators originated from the aneurysm were sacrificed, and the inferior devision of the middle cerebral artery was thrombosed in the postoperative period. Unfortunately, she showed a transient deterioration of her neurological status.

Two cases of neck clipping surgery for ruptured aneurysm in chronic hemodialysis patients

慢性透析患者に, 脳動脈瘤によるクモ膜下出血を併発した症例を2例経験した. 症例は50歳の男性 (Hunt Grade I) と38歳の女性 (Grade IV) で, 両症例とも頭部CT所見よりクモ膜下出血と診断し, 脳血管造影後, 減圧開頭neck clipping術を施行した. 術後は脳ヘルニアを防止するため減圧開頭を施行し, 脳浮腫の予防として高浸透圧製剤およびステロイドを通常の脳動脈瘤症例と同量使用した.また透析はクモ膜下腔内の出血防止と, 厳密な体液管理を行う目的で, 連日無ヘパリン透析を施行した. さらに透析による血漿浸透圧低下を防止する目的で高Na透析および高浸透圧製剤の持続点滴を行った結果, 透析中の血漿浸透圧, 頭蓋内圧および意識レベルをほぼ一定に保つことができた. 現在は両症例とも独歩可能で経過は良好である. 従って, 慢性腎不全という背景が存在した場合でも, 通常の脳外科的治療を基本として, 適切な血液浄化法を選択し, 施行すれば, 積極的な治療も充分可能であると考えられた.