Hidetsuna Utsunomiya

Cranial MRI of neurologically impaired children suffering from neonatal hypoglycaemia

Background. Metabolic disturbances such as anoxia and hypoglycaemia are important in causing maldevelopment of the neonatal brain. While there have been some pathology studies of the effects of neonatal hypoglycaemia on brain development, reports of MRI findings in such infants have been rare. Objectives. To describe the MRI findings in neurologically handicapped children who had suffered from neonatal hypoglycaemia and to evaluate the relationship between the neurological impairment and neonatal hypoglycaemia. Materials and methods. We retrospectively evaluated the MRI findings in eight full-term infants with neonatal symptomatic hypoglycaemia who later exhibited neurological handicap. The age at which the MRI scans were obtained ranged from 9 months to 8 years 10 months (mean 4 years 1 month, median 4 years). Results. The most striking findings were prolonged T1 weighting and T2 weighting in the parieto-occipital periventricular deep white matter in six patients, suggesting abnormal or delayed myelination. Dilatation of the lateral ventricles, especially of the trigones, was observed in five patients in whom the distance between the posterior horns of the lateral ventricles and the adjacent sulci was reduced. The volume of white matter relative to grey matter was reduced in two patients. In addition, four patients exhibited cerebral cortical atrophy, mainly in the occipital lobe. Conclusions. These findings suggest that neonatal hypoglycaemia may cause delayed or abnormal myelination, especially in the parieto-occipital, periventricular, deep white matter, and may cause cerebral cortical atrophy, especially in the occipital lobe.

Early computed tomographic findings for thrombolytic therapy in patients with acute brain embolism.

Background and Purpose The benefits and safety of thrombolytic therapy was studied in patients with acute brain embolism. Methods We intravenously administered recombinant tissue plasminogen activator (20–30 MU for 1 hour) to 10 patients with acute (<6 hours) brain embolism and examined the neurological outcomes in relation to the findings on computed tomography and angiography. Results The symptoms ameliorated in four patients within 24 hours after onset, and reopening of the occluded arteries occurred in two of the patients immediately after recombinant tissue plasminogen activator infusion. On the initial computed tomographic scan (<3 hours), four patients had already demonstrated early indications of brain ischemia, that is, an obscure margin of the lentiform nuclei, reduced tissue attenuation, or effacement of cortical sulci. These patients failed to demonstrate reopening of the occluded arteries, and one developed a massive brain hemorrhage with clinical deterioration. Of the remaining six patients, two obtained clinical improvement with recanalization soon after the therapy and demonstrated little to slight hemorrhagic complications. The outcomes at 1 month were favorable in five patients and poor in three; death occurred in two. Conclusions Thrombolytic therapy with recombinant tissue plasminogen activator may be safe and effective when there are no early computed tomographic findings within 3 hours from the onset of embolic stroke.

Giant cerebellar hemangioma in an infant.

A case is reported of an infant with a giant cerebellar vermis hemangioma which was totally removed. The excised specimen contained both cavernous angioma-like and telangiectasia-like portions with intervening cerebellar tissue. The tumor was considered to be a mixture of cavernous hemangioma and telangiectasia.

Neuroimaging findings (ultrasonography, CT, MRI) in 3 infants with congenital rubella syndrome

Neuroimaging observations of three infants with congenital rubella syndrome are reported. We have observed congenital rubella syndrome lesions in the subependymal area, the basal ganglia and the deep white matter. Cranial ultrasonography defines subependymal cysts, calcification and possible vascular changes in the basal ganglia while MRI is the most sensitive to minor atrophic changes and white matter lesions. Although CT defines calcification, it is less sensitive than MRI to white matter changes and does not demonstrate subependymal cysts.

Aicardi syndrome with holoprosencephaly and cleft lip and palate.

This 14-day-old Japanese girl demonstrated the classic features of Aicardi syndrome, including infantile spasms, agenesis of the corpus callosum, chorioretinopathy, microphthalmia, vertebral anomalies, electroencephalographic abnormalities, and severe mental retardation. Furthermore, she had a cleft lip and palate and a severe brain malformation due to semilobar-type holoprosencephaly. This patient is the second reported with Aicardi syndrome and associated cleft lip and posterior palate; she is the first patient with an additional severe brain malformation due to semilobar-type holoprosencephaly.

Rare neonatal intracerebral hemorrhage. Two cases in full-term infants

Intracranial hemorrhage in neonates is often found in either the subependymal area or the subdural space. The former is observed particularly in premature infants and is attributable to damage of the germinal matrix layer. The latter usually occurs in the vicinity of the falx and tentorium cerebri of full-term neonates and is thought to be caused by birth injury. Two cases of intracerebral hemorrhage in full-term newborn babies are reported. In both the hematoma was located at the left frontal area under the coronal suture. Angiograms revealed no causative signs, such as arteriovenous malformation, aneurysm or angioma. Observations on CT scans and during surgery led to the conclusion that the hemorrhages were caused by the moulding which forced the frontal bone to slip under the parietal bone at the coronal suture and then press on the fragile cerebral vasculature of the neonates, thus causing contusion.

MR imaging of birth brachial palsy in a two-month-old infant

A female baby at two months old was diagnosed as having birth branchial palsy and was studied by magnetic resonance imaging (MRI) which is a non-invasive and safe method for assessing any brachial plexus injury in the infant. A traumatic meningocele involving a root avulsion injury was clearly demonstrated by the MRI findings.

Multiple Brain Infarction and Hemorrhage by Nonbacterial Thrombotic Endocarditis in Occult Lung Cancer— A Case Report

A fifty-four-year-old woman died from multiple brain infarction and hemor rhage in the bilateral cerebrum, cerebellum, and brainstem, with renal infarc tion. She developed hematuria and transient blindness sixteen days before admission. Low-grade fever, heart murmur, and aortic valve vegetation on ul trasonic cardiography suggested infectious endocarditis. Autopsy study re vealed occult adenocarcinoma in the lung and nonbacterial thrombotic endocarditis, but infective endocarditis was not histologically confirmed. The patient was considered to be a rare case of nonbacterial thrombotic endocarditis who developed multiple small infarctions mainly in the brainstem and cerebel lum. Nonbacterial thrombotic endocarditis seems to be still an important dis ease as the embolic source, even if cryptic, of systemic thromboembolism.

Cerebellar Vermis Bleeding in a Patient with Hemophilia A A Case Report

A seventeen-year-old man with hemophilia A developed nausea, vomiting, and unsteady gait after mild head trauma. Magnetic resonance imaging clearly demonstrated localized bleeding in cerebellar vermis. Quick administration of factor VIII concentrates prevented further extension of the bleeding and the patient completely recovered without neuro logic impairment. In hemophiliac patients, careful evaluation of intracranial lesions is desired after head trauma even if they show only nonspecific symptoms.

Clinical and Brain Hemodynamic Evaluations of Thrombolytic Therapy in Acute Ischemic Stroke: SPECT Study

Thrombolytic therapy has been proposed as a promising therapy for acute ischemic stroke when it is initiated very early after the onset of stroke symptoms [2, 6, 7]. However, thrombolytic therapy may not be reliably applied when the patients are evaluated based on clinical signs only. The absence of early CT hypodensity before the therapy may be one implication for safe and effective thrombolysis [7]. Recently, single photon emission tomography (SPECT) has been used in the examination of emergency patients. It may also be useful for the early diagnosis of ischemic stroke, and especially reperfusion after thrombolytic therapy in acute ischemic stroke [4]. In the present study, we describe preliminary results of regional cerebral blood flow (rCBF) SPECT imaging at fixed intervals before and after thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA), and correlate them with the clinical and angiographic outcomes.