Kunio Yamamura

Relationship between the clinical manifestations, computed tomographic findings and the outcome in 80 patients with primary pontine hemorrhage

The relationship between the clinical manifestations, computed tomographic (CT) findings and the outcome in 80 patients with primary pontine hemorrhage (PPH) was analyzed to clarify factors predicting the outcome. Patients were 58 males and 22 females (60. 5+/-12.9 years old) with PPH. Correlations between the clinical manifestations, CT findings and the outcome was assessed with multivariate regression analysis. The initial level of consciousness and the transaxial size of the hematoma on CT were strongly related to the outcome. In patients with small hematoma (with the transaxial size </=20 mm), pupillary abnormalities of onset and acute hydrocephalus were related to the outcome of PPH.

Suprasellar germinoma occurring two years after total removal of pineal teratoma

A rare case of a suprasellar germinoma occurring 2 years after total removal of a pineal benign teratoma is presented. The suprasellar germinoma was not considered a recurrence or dissemination from the pineal tumor, but to have been transformed from germ cells present in the suprasellar region. Although it is controversial whether radiation treatment should be given to a patient with a totally removed benign teratoma, careful follow-up computed tomography scans are indispensable for detecting a possible occurrence of other germ cell tumors.

Aphasia following left putaminal hemorrhage. Statistical analysis of factors affecting prognosis

Abstract Multivariate and single variable analyses were employed to investigate the recovery mode of aphasia in right-handed patients with putaminal hemorrhage on the left side. Speech disturbance was evaluated using the standard language test for aphasia (SLTA) at intervals of 1, 3 and 6 months after the ictus. Recovery was assessed in relation to age, gender, volume and location of hematoma, and treatment modalities. Extension of the hematoma into the corona radiata was the factor that dominated the prognosis of aphasia at all intervals during the follow-up period. Good recovery was documented in patients with less than 2 cm2 of the hematoma volume located in the corona radiata. Recovery was poor, however, in patients with more than 12 cm2 of the hematoma in the corona radiata. While aphasia continued to improve over 6 months after the ictus, recovery was more prominent in the first 3 months. Our study precisely demonstrated that the extension into the corona radiata independently and strongly influenced the outcome of aphasia in patients with left putaminal hemorrhage.

The Effects of Atrial Natriuretic Peptide on Brain Edema, Intracranial Pressure and Cerebral Energy Metabolism in Rat Congenital Hydrocephalus

Atrial natriuretic peptide (ANP) regulates fluid and electrolyte homeostasis in the central nervous system. In this study, we evaluated the effects of ANP on brain edema, intracranial pressure (ICP) and cerebral energy metabolism in congenital hydrocephalus in rats. Brain edema, indicated by the longitudinal relaxation time (T1), was evaluated by 1H-magnetic resonance imaging (MRI). The ICP was monitored with a miniature pressure-transducer with telemetric system. Cerebral energy metabolism, indicated by PCr/Pi ratio, was measured by 31P-magnetic resonance spectroscopy (MRS). The rats were given 10 microliters of ANP in the left cerebral ventricle. Three different concentrations of ANP were given; 0.2 (group I), 2.0 (group II) and 20.0 (group III) micrograms/10 microliters, respectively. 10 microliters of saline was injected into the ventricle of the control group rats. There were no significant changes of ICP, T1 value and PCr/Pi ratio among the control group, group I and group II. In group III, in contrast, ICP decreased significantly at 20 minutes after ANP administration and stayed at this ICP level for 60 minutes. The T1 value decreased and PCr/Pi ratio increased 30 minutes after ANP administration. This study revealed that intraventricularly administered ANP could decrease ICP, reduce brain edema and improve the cerebral energy metabolism in rats with congenital hydrocephalus.

High Energy Phosphate Metabolism in Congenital Hydrocephalic Rats — an in Vivo 31P Magnetic Resonance Spectroscopy Study

We used phosphorus-31 magnetic resonance spectroscopy (31P-MRS) to obtain in vivo measurements of cerebral energy matabolism and intracellular pH in congenital hydrocephalic rats (HTX). The hydrocephalic group consisted of 20 rats and the non-hydrocephalic group consisted of 15 rats. The rats in the hydrocephalic group were subdivided into three smaller groups according to the degree of hydrocephalus (mild, moderate, and severe). The PCr/Pi ratio was used as the chosen indicator of cellular bioenergetic status.

Effects of Atrial Natriuretic Peptide on Intraventricular Pressure in Rats with Congenital Hydrocephalus

Using congenitally developed hydrocephalic rats, the functional effect of intraventricularly administered atrial natriuretic peptide (ANP) on intraventricular pressure and brain water and sodium content was investigated. Physiological saline and 0.2 μg of ANP did not induce any change in these three parameters. In contrast, 2 μg of intraventricular ANP induced a significant decrease of intraventricular pressure. Brain water and sodium content were also decreased, but not to a statistically significant extent.

Epidemiological Survey of the Management of Fetal Hydrocephalus in the Kansai District of Japan

In order to carry out an epidemiological survey on the management of fetal hydrocephalus, a questionnaire was sent to 179 major hospitals belonging to the Kinki District Obstetrical Gynecological Society. The authors studied the clinical state at discharge from the obstetrical institute and the follow-up results in 38 cases of fetal hydrocephalus identified in this survey. Of 28 infants delivered alive, 19 were shunted. Most shunts were placed within two weeks postnatally. Of 19 infants shunted, 9 experienced shunt complications and subsequently underwent shunt revision. Postnatal clinical outcome was classified into three grades according to the developmental quotient (DQ) of the infants. Of 20 infants born alive, 8 were normal, 5 were slightly disturbed, and 4 were severely disturbed. The clinical outcome in infants with hydrocephalus caused by aqueductal stenosis was better than that reported by other authors. The clinical outcome in infants with early shunt was better than in those without it. Early ventricular shunting following early induction of delivery was performed in nine infants. Infants treated this way had a better outcome than those not so treated. At the last assessment, the degree of both ventricular dilatation and brain atrophy found on imaging studies correlated well with the degree of neurological disturbance.