Noriko Saito

The Ishikawa classification of cavernous sinus lesions by clinico-anatomical findings.

PURPOSE The Jefferson classification has been used to localize cavernous sinus lesions. However, this classification occasionally showed dissociation between identified localization and clinical findings. We investigated the clinical applicability of the newly proposed Ishikawa classification based on serial topographic sections of human cavernous sinus and the clinical findings. METHODS In the Ishikawa classification, the cavernous sinus is divided into three portions, that is, anterior, middle, and posterior, demarcated by the location of the intracranial orifice of the optic canal and the entry of the maxillary nerve into the cavernous sinus. A total of 162 patients with cavernous sinus lesions were classified using both the Jefferson and the Ishikawa classifications and the clinical applicability of these two classifications was studied. Characteristics of the localization of lesions were also examined in each etiological type. RESULTS By the Jefferson classification, 11% of the 162 patients had the anterior type of lesion, 12% the middle, 8% the posterior type, and 69% the unclassifiable type. However, by the Ishikawa classification, 35% had the anterior type, 10% the middle type, 22% the posterior type, 5% the whole type, and 28% the unclassifiable type of lesion. Furthermore, the Ishikawa classification revealed that the etiology of the anterior type was mainly inflammation, and that the etiology of the posterior and whole types was tumors. CONCLUSION The Ishikawa classification is clinically useful to identify and classify the localization of cavernous sinus lesions.

Optic Tract Syndrome, Horner's Syndrome, and Trochlear Nerve Palsy due to Suprasellar Germinoma

We report a 23-year-old man with suprasellar germinoma accompanied by optic tract syndrome, Horners syndrome, and trochlear nerve palsy. Neuroimaging demonstrated that the optic tract, the hypothalamus on the left side, and the trochlear nerve in the subarachnoid space were involved by a germinoma. In addition to neuroimaging findings, detailed observation of various ocular symptoms was highly useful for determining the localization of the germinoma.

Therapeutic effect of tiopronin followingd-penicillamine toxicity in a patient with rheumatoid arthritis

Tiopronin (~-mercapto-propionyl-glycine) is a sulphydryl compound with a chemical structure similar to that of penicillamine [1]. In Japan, this drug is used to treat patients with hepatitis and its use for rheumatoid arthritis (RA) has been approved in Europe [1-3]. Because of limited clinical use of tiopronin in RA patients, the number of reports supporting the therapeutic efficacy of tiopronin is limited in Japan. Tiopronin also shares the pharmacological actions of penicillamine, suggesting that patients allergic to penicillamine may also show adverse reactions to tiopronin. However, we encountered a patient with Dpenicillamine-induced jaundice [4] who responded well to tiopronin. We report the background and clinical course of this patient.

Isolated Bilateral Abducens Nerve Palsies Due to Metastasis to the Clivus from Adenocarcinoma in the Lung

Isolated bilateral abducens nerve palsies due to clivus tumor have rarely been reported. We report on a 71-year-old woman with isolated bilateral abducens nerve palsies probably caused by metastatic clivus tumor from an adenocarcinoma in the lung. She complained of diplopia due to right abducens nerve palsy. Two weeks later, left abducens nerve palsy also appeared. Cranial magnetic resonance imaging showed a gadolinium-enhanced lesion in the clivus. Computed tomography of the chest demonstrated a lesion in segment 9 of the left lung. Biopsy of this lesion confirmed adenocarcinoma. When we encounter isolated bilateral abducens nerve palsies, clivus tumor, including metastasis from lung carcinomas, should be considered.