Minoru Nakagawa

Improvement of Depression after Treatment of Dural Arteriovenous Fistula: A Case Report and a Review

Patients with dural arteriovenous fistulas (DAVFs) in the transverse-sigmoid sinus suffer from several symptoms: bruit, headache, visual impairment, and so on. But depression is rare in patients with DAVF. The authors reported a rare case presenting the improvement of depression after the treatment of a dural arteriovenous fistula in the left transverse-sigmoid sinus. A 46-year-old male had suffered from depression and was treated with antidepressants at a local hospital for four years. The patient was temporarily laid off due to his depression. Afterwards, he had Gerstmanns syndrome and came to our hospital. A DAVF in the left transverse-sigmoid sinus was demonstrated on the angiogram. The DAVF was successfully treated with endovascular surgery, coil embolization of the isolated diseased sinus through the mastoid emissary vein which was a draining vein from the fistula. After this treatment, his depression as well as Gerstmanns syndrome was improved and the quantity of the antidepressants decreased. The patient returned to work without any antidepressant two years after the treatment. DAVFs might be one of the causes of depression. It may be necessary to evaluate cerebral vessels in patients suffering from depression by using MRA or 3D-CTA even if there are not any abnormal findings on plain CT scans.

Thrombosis of the Draining Vein of a Venous Angioma Manifesting as Seizure: A Case Report and Review

We present a rare case with a generalized tonic seizure due to thrombosis of the draining vein of a venous angioma. A 78-year-old woman suddenly developed a generalized tonic seizure and fell down backward with occipital head injury. A computed tomographic scan without contrast showed a low-density area with central high density in the left parietal white matter, including a left acute subdural hematoma and a left frontal contusional hematoma. At left carotid angiogram, a venous angioma in the left parietal paraventricular region with a draining vein toward the superior sagittal sinus in the venous phase was observed, and the contrast medium did not drain away from the junction between the draining vein and superior sagittal sinus. In this case, the thrombosis of the draining vein of a venous angioma caused a venous infarction with a partially hemorrhagic lesion and then induced a generalized tonic seizure. An oral anticonvulsant was given and followed by oral antiplatelet drug after the hemostasis of intracerebral hemorrhage. The patient was discharged without any neurological deficit and recurrence of seizure.

The rebuilding of normal venous circulation for transverse-sigmoid dural arteriovenous fistulas by percutaneous transluminal angioplasty. A case report.

The etiology of dural arteriovenous fistulas (DAVFs) remains controversial as is the issue of whether occlusion or stenosis of the transverse sinus and sigmoid sinus is a cause or a result of DAVFs. We report a case of DAVFs with transverse-sigmoid sinus occlusion and cortical venous reflux. In this case, the reconstruction of normal venous circulation by percutaneous transluminal angioplasty (PTA) for the occluded sinus was performed and cortical venous reflux diminished. PTA may be a useful treatment for DAVFs with occluded or stenotic sinus.

The Relationship Between Nucleolar Organizer Regions and Hormone-Producing Activity in Pituitary Adenoma

Nucleolar organizer regions (NORs) are loops of DNA which contain ribosomal RNA genes. Recently the number of NORs has been reported to be a marker of histological malignancy [1] or proliferative potential of the tumor cell [2–5]. Fundamentally, however, NORs contribute to protein synthesis. In this study, the relationship between the number or the size of NORs and hormone-producing activity was examined in pituitary adenoma.