Mitsuo Kaneko

Primary pontine hemorrhage and gustatory disturbance: clinicoanatomic study.

A clinicoanatomic study of 12 patients with tegmental-type primary pontine hemorrhage proved the presence of a gustatory disturbance among other clinical symptoms on the same side of the tongue as that of the pontine lesion, and suggested the secondary pathway of gustatory sensation from the solitary tract nucleus ascends without decussation in the homolateral pontine tegmentum. These results contradict textbook descriptions regarding the human secondary gustatory pathway.

CT classification of small thalamic hemorrhages and their clinical implications

Thirty-seven small thalamic hemorrhages (less than 2 cm) were classified into four types depending on topographic location. Patients with posterolateral lesions had severe sensory and motor disability as well as the worst prognosis. Anterolateral lesions resulted in mild prefrontal signs with milder sensory and motor impairment. Medial hematomas disturbed consciousness in the acute stage, followed by impaired prefrontal signs of long duration. Dorsal hematomas were associated with ipsilateral parieto-occipital signs (aphasia on the left and topographic memory disturbance on the right).

Primary pontine hemorrhage: clinicopathological correlations.

In 18 autopsies from patients with primary pontine hemorrhage we studied the sites of bleeding, the volumes and development of hematomas and clinicopathological correlations. A modular optical electronic planimeter was introduced to measure the size of hematomas. The series of patients can be divided into 2 groups from the viewpoint of bleeding sites, their development and clinical symptomatology. These are 1) the tegmentobasiiar type and 2) the tegmentai type. The precise location of the orgin of hemorrhage, and the approximate volume of hematomas can now be determined with the help of computerized tomography. This information will be of help in understanding clinical symptoms. Two different typical patient reports, selected from the collection, are presented.

Correlation between the location of hematoma and its clinical symptoms in the lateral type of hypertensive intracerebral hemorrhage. Observations on Pantopaque radiography of the hematoma cavity in cases of early surgical treatment.

The authors studied the Pantopaque radiograms of a hematoma cavity5 in 46 patients following early surgical treatment for the lateral type of hypertensive intracerebral hematoma. All patients were operated on within 7 hours after the apoplectic attack4 and most of them had a localized hematoma. It was concluded that they could be classified in three subtypes from the location of hematoma in the antero-posterior direction. Each subtype had particular clinical symptoms and prognosis.

How to Determine a Cryptic AN. Malformations. Clinico-Pathological Study of 16 Cases

The frequency of determination of cryptic AVM largely depends on the method of search during surgery. We introduced our method here together with a discussion of the microscopic and electron microscopic views. Generally, cryptic AVM is rarely found by angiography, and the key to its discovery is a skillful and thorough search for it during surgery rubbing all under a surgical microscope, the wall of the hematoma cavity is rubbed all over with a piece of cotton soaked with physiological saline solution, and a histological specimen is obtained from the easily-bleeding portion. We have performed patho-histological examinations on these specimens. In the last six years, we had 16 cases of histologically confirmed cryptic AVM, among them 12 cases were in the subcortex, and four in the brain stem. We suspected cryptic AVM in 15 cases having no histories of hypertension or blood diseases. Among these we found small nidi and achieved histological confirmations in 12. Of these 12, only seven had been found to have cryptic AVM by pre-operative angiography. They were found most frequently in the frontal lobe (8 cases), followed by the temporal lobe. In almost all, onset of cryptic AVM was relatively slow in spite of the presence of hematoma. Consciousness was clear and the outcome was generally good. Most of them were found in younger age groups, but we did find a few in older groups. In the four cases of cryptic AVM in the brain stem, there had been no particular indications of it before the operation. We are of the opinion that conventional histological classification of cryptic AVM is not adequate in view of the actual status.

Clinico-pathological Study of Ruptured Intracranial Aneurysm in Acute Stage

During the past three years, we admitted 326 cases of cerebro-vascular disease which included 109 cases of intracranial hematoma and 67 cases of ruptured intracranial aneurysm. Of those aneurysm cases, 36 cases were admitted in acute stage or within 24 hours after the attack. On admission, 27 cases of them showed severe disturbance of consciousness with the grade of 4 or 5. 12 cases died in acute stage and 11 cases of them were autopsied. On postmortem examination all of them showed severe primary cerebral damage and massive subarachnoid or intracerebral hemorrhage. The extension of subarachnoid and intracerebral hematoma depended upon the location of the aneurysm and the direction of its dome. Among 11 autopsy cases 8 cases had massive subarachnoid hematoma and 8 cases had intracerebral hematoma. 6 cases of them had associated ventricular perforation. Though it was difficult to clarify the mechanism of the acute death, the following conditions seemed to be contributing; massive subarachnoid hematoma in basal cistern surrounded the brain stem and constricted it. The basal artery was streched and separated from the brain stem. Ventricular perforation often caused early tentorial herniation and developed secondary midbrain hemorrhage. There would be still considerable cases in which if they were admitted in the early stage after the attack and had the hematoma removed, they could be rescued with satisfactory function. In our series of acute cases, one third of them was succeeded to return to the social life.

Pathological study on cerebral embolism with special reference to the vascular changes in infarct.

急性期脳塞栓症の剖検例15例の梗塞巣内血管病変を組織学的に検索し, その成立機序ならびに出血の機序について考察した.14例に, 点状ないし斑状出血, およびこれらの融合した塊状の出血が梗塞巣内に生じていた.血管病変の基本像は, 血管透過性の充進とそれに基づく組織融解であり, その組織像は, 毛細血管, 細動静脈のフィブリノイド変性と内腔を閉塞する血栓, 小動脈の内膜, ときに中膜に及ぶ好中球浸潤と限局性の中膜壊死, 内中膜のフィブリノイド変性, 壁の解離小静脈壁の血漿浸潤による壁膠原線維の融解と断裂であった.出血は, 細血管からの漏出と小動静脈の破綻により生じていた.小動脈の破綻は, 血管攣縮に起因したと考えられるフィブリノイド変性や解離により, また小静脈の破綻は, 好中球や単球の浸潤による壁の組織融解によると考えられた.こうした血管病変が存在する梗塞巣内への血流再開は, 出血や浮腫を助長, 増悪する因子と考えられる.

Peracute Revascularization for the Cases of Major Trunk Occlusion of Major Stroke Type

For the past 7 years, we have accumulated experience of peracute revascularization for the cases of major trunk occlusion of major stroke type. Since we adopted the dynamic CT scan 5 years ago, it became far easier and clearer to decide the indication for surgery in a short period of time.

Neuropathological sutdy for acute severe cerebral infarction

重症脳梗塞で死亡した4症例につき, CT所見と剖検における病理学的所見を検索し, さらに大脳半球大梗塞モデル犬で得た病理学的所見とを対比して検討を加えた. (1) 剖検例と実験例で類似の病理学的所見を得た.すなわち中大脳動脈領域に広範囲な梗塞巣があり, その中に塊状出血巣と点状出血巣の2つの病巣の局在をみとめた. (2) 塊状出血巣はperforating arterial terminal zoneである大脳基底核の細動脈からの出血であり, 点状出血巣はcorticalarterial terminal zoneである皮髄境界の細静脈からの出血であった. (3) CT所見では, 大脳半球のほぼ全体に及ぶ低吸収域を示し, contrast enhancement陰性であった.出血が少量のため脳浮腫にmaskingされて, 高吸収域として検出することができなかったと考えられる.したがって重症脳梗塞では, 梗塞巣の中に塊状出血巣と点状出血巣の異なる病巣の局在を区別して考える必要がある.

Clinicopathological study in cases of fulminant hemorrhage in the basal ganglia or thalamus

過去6年来脳卒中の早期診療に努め, 外側型脳出血に対しては超早期手術を推進してきたが, この様な大脳基底核部出血中には約10%前後の割合で発症後2～3時間以内に脳幹症状を呈して不可逆状態に陥いる激症型と呼ぶべき脳出血症例がある.短時間で死亡するため剖検の承諾を得るのは非常に困難であるが, この様な激症経過をとった大脳基底核部13例について剖検を得, 興味ある結果を得た. (1) 外側型 (被殻外包) 出血では短時間で大血腫を形成し, 血腫そのものにより脳ヘルニアを生じ, また中脳, 橋上部に続発性出血を起こしていたs全例に中脳の圧排, 挫滅, 変形, 出血のいずれかが認められた. (2) 激症経過をとった視床出血では血腫は下方に進展し, 直接に視床下部, 中脳を破壊していた. (3)「混合型」出血の多くは視床出血の進展型と考えられた. (4) いずれの例にも延髄, 下部橋には肉眼的所見を認めず上記の様な中脳の破壊が死亡の主因をなすと考えられた.