Kiyoshi Narushima

Differentiation of mechanism and prognosis of traumatic brain stem lesions detected by magnetic resonance imaging in the acute stage

We retrospectively evaluated the MRI from 17 patients with primary brain stem injury obtained in the acute stage. Clinical and radiological findings were analyzed in these 17 patients. T2-weighted imaging proved to be most sensitive and specific for the diagnosis of primary brain stem injury. We found two patterns of brain stem injury. The good prognosis group showed ventral brain stem lesions or dorsal superficial brain stem lesions. On the other hand the poor prognosis group showed deep dorsal brain stem lesions. These acute stage findings are seen only temporally in many cases so that it is most important to examine MRI findings in the acute stage to evaluate the prognosis of the patient. MRI was valuable in predicting the outcome. The possible mechanism of brain stem injury in patients with head injury is briefly discussed.

Postoperative brainstem high intensity is correlated with poor outcomes for patients with spontaneous cerebellar hemorrhage.

OBJECTIVE The outcomes for patients with cerebellar hemorrhage are thought to be influenced by anatomic damage to the brainstem. In this study, we investigated the magnetic resonance imaging findings in the brainstem, to examine the relationship between the degree of brainstem damage and the outcomes for patients with spontaneous cerebellar hemorrhage who are in poor-grade condition. METHODS The results for 31 patients with spontaneous cerebellar hemorrhage, with Glasgow Coma Scale scores of 8 or less at admission, who underwent magnetic resonance imaging examinations were reviewed. All patients underwent surgical intervention. The patients were divided into two groups according to their Glasgow Outcome Scale scores at the time of discharge, i.e., patients who experienced good recoveries or exhibited moderate disabilities (Group I, n = 8) and patients who exhibited severe disabilities, were in a persistent vegetative state, or had died (Group II, n = 23). We investigated obliteration of the fourth ventricle and the perimesencephalic cistern and the presence of hydrocephalus in initial computed tomographic scans and the presence of areas of high signal intensity in the brainstem in T2-weighted images. RESULTS Eight patients experienced good outcomes, and 23 patients experienced poor outcomes. The overall mortality rate was 32.3%. There were no significant differences between groups with respect to computed tomographic findings such as hematoma size, but the incidence of high signal intensities in the pons and midbrain in T2-weighted images for Group II was significantly higher than that for Group I (P < 0.01). CONCLUSION Magnetic resonance imaging clearly demonstrated brainstem damage, and high signal intensity in the brainstem was a significant prognostic factor for determining outcomes for patients with spontaneous cerebellar hemorrhage who were in poor-grade condition.

Multiple Arteriovenous Malformations of Spinal Cord and Brain in a Child

A case of concurrent intracranial and spinal cord arteriovenous malformations (AVMs) is described. A 3-year-old girl presented with paraparesis, bladder-bowel disturbances and bilateral dysesthesia of the lower extremities due to a spinal hematoma, resulting from a spinal AVM. Magnetic resonance imaging revealed a hematoma and abnormal vessels in the spinal cord. The AVM was embolized with polyvinyl alcohol particles and silk sutures and was surgically removed. Later, this girl presented with disturbance of consciousness due to an intraventricular hemorrhage, resulting from a cerebral AVM. The cerebral AVM was surgically resected. The coexistence of bleeding cerebral and spinal AVMs is very rare.

Tumor cord and growth in human brain tumors based on mathematical morphology

SummaryThe growth of human brain tumor was quantitatively investigated by using the anti-bromodeoxyuridine (BrdU) monoclonal antibody and the texture analyzing system (TAS). Tissues from thirty eight patients consisting of 22 gliomas, 8 brain metastases, 1 cerebellar hemangioblastoma and 7 normal white matters were applied in this study. Mean values of growth fractions (GFs) were 29.4% in group 1, 14.8% in group 2, and 6.5% in group 3. The higher value of GFs showed a significantly larger degree of perivascular aggregation of S-phase cells (DPAS). The mean number of cells in each tumor cord was approximately 20, which is not significantly larger than that of the normal group. But there was a significant difference between the non-selected area of the histologically malignant or benign gliomas and the proliferating area of the biologically malignant or benign brain tumors (t-value; p<0.001). A significant difference was also noticed in the mean area and diameter of tumor cords (t-value; p<0.001).From the point of view of biological behavior in human brain tumor, it is suggested that one tumor cord contains approximately 20 viable cells in the proliferating area in both benign and malignant brain tumors, and that if viable cells increase to more than 20 cells in one TC, necrotic cells and the diameter and area of the TC will increase, because the vessel-density is decreased by the occlusion of the vessels and the death of the endothels.

Intracerebral hematoma developing during MR examination

We report a case of a 78-year-old woman with cerebellar infarction who developed intracerebral bleeding during the magnetic resonance (MR) examination. The intensity of the hematoma was heterogeneous corresponding to the heterogeneous density shown on CT study that immediately followed the MR examination.