Haruyuki Kanaya

Aneurysm of the distal anterior inferior cerebellar artery unrelated to the cerebellopontine angle: case report.

This is a case report of an unusual aneurysm of the distal anterior inferior cerebellar artery. A 44-year-old woman had a severe frontal headache and vomiting of sudden onset. On the day after admission, the patient began to demonstrate nuchal rigidity and difficulty with upward gaze bilaterally. There were no complaints at this time suggestive of a syndrome of the cerebellopontine angle. A computed tomographic scan revealed an intraventricular hemorrhage of the 3rd and 4th ventricles; however, multiple attempts at four-vessel angiography were required before an aneurysm could be demonstrated. On the 28th hospital day, a suboccipital craniectomy using the retromastoid approach in the lateral position was performed. A saccular aneurysm with a surrounding hematoma in the distal anterior inferior cerebellar artery was found and clipped. The operative findings revealed that the aneurysm was unrelated to the cerebellopontine angle. After surgery, the patient had an uneventful recovery and complete resolution of symptoms.

Multiple meningiomas in the posterior fossa

A case of multiple meningiomas in the posterior fossa is reported. Computed tomography scans clearly demonstrated the tumors. They were removed completely and the patient was discharged without any neurological deficits. The clinical features are discussed and the pertinent literature is reviewed.

PRIMARY CEREBRAL MALIGNANT LYMPHOMA OF THE HISTIOCYTIC TYPE

A 60‐year‐old house wife complained of anorexia, headaches and vomiting for several months. Later she developed disturbances in gait. At the terminal stage of her clinical course, 3 masses in the cerebrum and one in the cerebellum were detected by angiography and CT‐scan. At autopsy, 3 masses in the frontal lobes, and one in each thalamus and still another in the cerebellum were found. They were accompanied with necrotic and haemorrhagic changes. Tumor cells were large irregular or round in shape, and showed metallophilia by the silver impregnations for reticlum cells and microglia. Some of them were multinucleated giant cells. Tumor cells showed occasionally phagocytic activity. Perivascular infiltration of tumor cells was marked around the tumor masses.

A Case of Isolated Fourth Ventricle Due to Ruptured Cerebral Aneurysm

We present a case of isolated fourth ventricle which developed after massive ventricular hemorrhage, due to a ruptured cerebral aneurysm. In an adult an isolated fourth ventricle seems to be very rare, also the symptom of unconsciousness and respiratory arrest and the rapid development in this case seemed very unusual. The aqueductal occlusion was considered to be related to the intraventricular hematoma which remained as clots over a 2-month-period of time. This case was a 57-year-old woman admitted to our hospital in a state of coma. CT showed a massive ventricular hematoma and right carotid angiogram showed an aneurysm of the anterior communicating artery. Bilateral ventricular drainage was performed because of progressive decerebrate rigidity. Since consciousness gradually arose to the Japan Coma Scale 3, clipping of the neck of the aneurysm was performed 25 days after onset. Premature rupture occurred during the operation. After surgery, CT Showed ring-like high densities due to the premature rupture of aneurysm in both lateral ventricles, and also in the fourth ventricle as well. Although the lateral ventricles drainage functioned effectively, the fourth ventricle showed remarkable gradual dilatation. The patient was stuporous, but respiratory arrest occurred suddenly 43 days after onset. Since it was considered that the intraventricular hematoma blocked the aqueduct, the same as in the outlet of the fourth ventricle and that the dilated fourth ventricle compressed the brain stem, the ventriculostomy was performed through suboccipital craniectomy. The cerebellar hemispheres showed remarkable swelling bilaterally, and no cerebrospinal fluid was found in the cisterna magna.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography before and after radiotherapy for a thalamic tumor

SummaryA patient with a thalamic tumor received radiotherapy. A right cerebral angiogram seven days after the irradiation was finished revealed increased vascularity, early filled deep cerebral veins and signs of increased mass. A subsequent angiogram showed gradual regression of these features. There is no literature on angiographic progression with early venous filling following radiotherapy.

Regional cerebral blood flow in patients with hypertensive intracerebral hemorrhage (putaminal hemorrhage)

高血圧性脳出血のうち被殻部出血において, Xe 133内頚動脈内注入法を用いて脳循環を測定し, 主としてその半球平均血流量 (MCBF) と運動機能を中心として種々の検討を行なった.MCBFは発作後1年以内においては, どの時期においても約30ml/100g/min.前後の低値を示した.個々の症例におけるMCBFの経時的変化をみると, 大半は長期にわたり低値を示し, 血腫量による差を認めなかった.しかし, 小血腫例の中には短期間にMCBFの回復を示すものもみられた.発作後3ヵ月以内の症例においては, 血腫量が大きい程MCBFが低値を示す傾向がみられた.運動機能障害とMCBFの関係は, 上下肢共に麻痺の程度が強いもの程MCBFが低値を示す傾向がみられた.CT上の内包後脚圧迫型と破壊型の間にはMCBFの回復において差がみられるが, そのことと運動機能の改善との間には一定の関連性はみられなかった.

52. Neurological Analysis on Surgical Indication of Hypertensive Intracerebral Hemorrhage and its Results

2) The recovery of hemiplegia could not be expected in cases with hematoma extended into lateral ventricle destructing the internal capsule. The major aim of surgery is life saving in these cases. 3) The prognosis for hemiplegia by the surgical evacuation was significantly better than that of conservative management in cases with the hematoma spread into a part of the posterior limb of internal capsule. Surgery is advisable for this type of hemorrhage. 4) The severity and prognosis of hemiplegia in putanimal hemorrhage was