Hideyuki Suwa

A post-traumatic ligamentum flavum progressive hematoma: a case report.

STUDY DESIGN A case report. OBJECTIVES To understand a rare case of ligamentum flavum progressive hematoma. SUMMARY OF BACKGROUND DATA Previously there were only two reports about ligamentum flavum hematoma. METHODS A patient was surgically treated for ligamentum flavum hematoma causing progressive L5 radiculopathy. Clinical and neuroradiologic features were reported, and the literature was reviewed. RESULTS The etiology of this case could not be defined except by minor back injury. In spite of conservative therapy, the symptoms were progressive for 7 months. Magnetic resonance imaging demonstrated the epidural mass lesion at L4-L5 that was continuous with the ligamentum flavum. The mass was hypointense in T1-weighted images and central hyperintense and marginal hypointense in T2-weighted images. The margin was well enhanced by Gd-DTPA administration. After removal of the mass lesion, the patients symptoms completely resolved. Before surgery, accurate diagnosis was difficult even based on magnetic resonance imaging and was achieved after histologic examinations. CONCLUSIONS Surgery could be a choice of the treatment modality to resolve symptoms in ligamentum flavum hematoma.

The significance of the cervical soft disc herniation in the ossification of the posterior longitudinal ligament.

The significance and role of cervical soft disc hernia in ossification of the posterior longitudinal ligament were investigated based on 54 surgical cases. The types of ossification of the posterior longitudinal ligament were divided into three sub-types: segmental, continuous, and mixed types. In the current series, there were 29 segmental type, 12 continuous type, and 13 mixed type. In the 29 segmental type, 23 patients had accompanying cervical disc hernias (79%). In the 12 continuous type, only 2 patients (17%), and in the 13 mixed type, 5 patients (33%), had accompanying disc hernias. According to the current study, an essential difference exists between the segmental type and the continuous or mixed types. In addition, the current result seems to indicate that, at least in the segmental type, disc herniation is not the promoting or initiating factor of ossification of the posterior longitudinal ligament, but that, in these cases, the fragility of the posterior longitudinal ligament may increase the chance of a disc hernia.

Successful removal of a huge falcotentorial meningioma by use of the laser

Abstract The successful removal of a huge falcotentorial meningioma in a 49-year-old woman is reported, with emphasis on the following points: multiplanar CT enabled three-dimensional localization of the tumor; a CO 2 laser unit provided easy hemostasis in deep portions of the tumor; and a two-stage operation was advantageous.

A case of recurrent minor stroke accompanied by pulmonary infarction.

2回にわたり, 脳梗塞と肺梗塞を繰り返した症例を報告し, その共通する危険因子について検討した.症例は45歳の男性で, 右中大脳動脈と前大脳動脈の分水嶺領域と左前大脳動脈の終末領域に脳梗塞を生じた.肺梗塞は, 1回目の脳梗塞発作後, 暫くして行われた腰椎椎間板ヘルニア切除後の安静仰臥中と, 2回目の脳虚血発作による右下肢不全麻痺後の臥床状態の時に生じた.入院中に著明な起立性低血圧が認められ, 2回目の脳虚血発作は過度の飲酒と入浴後に生じていた.本症例の脳梗塞と肺梗塞の共通の危険因子としてはplatelet factor 4とβ-thromboglobulinの上昇で示される血小板凝集能の充進があり, これが基盤になり, 起立性低血圧によるhemodynamic factorと飲酒あるいは入浴によるhemoconcentrationが重なり, 脳梗塞が生じたと考えられた.肺梗塞は血小板凝集能充進状態に, 臥床状態が重なり生じたと推察された.