Ryoji Ishii

Intelligence in children with moyamoya disease: evaluation after surgical treatments with special reference to changes in cerebral blood flow.

The effect of surgical treatment upon the intelligence of 20 children with moyamoya disease was evaluated and related to changes in cerebral blood flow (CBF). The patients were treated by various surgical revascularization procedures, mainly by encephalo-myo-synangiosis. Intelligence was tested using the Wechsler intelligence scale for children (WISC) in 19 children and the Wechsler adult intelligence scale (WAIS) in one child. Measurements of regional CBF were performed by al33Xe inhalation method. In the preoperative state, the degree of reduction in the intelligence quotient (IQ) correlated well with the age of the patients; the older patients revealed a more marked reduction of IQ, and the patients with lower Intelligence scores in general showed a tendency for more marked depression of mean CBF. Postoperatively, most of the patients showed increase in IQ, especially in performance IQ which im- proved significantly in 10 patiens, remained unchangd in 3 and deteriorated in 2. Mean CBF increased by an average of 11.4%, and postoperative changes in mean CBF correlated well with the changes in IQ in most patients. This may show that the postoperative increase in CBF is quite possibly responsible for the changes in IQ. Stroke Vol 15, No 5, 1984

Cerebellar hemorrhage complicating cervical durotomy and revision C1-C2 fusion

Study Design A case of cerebellar hemorrhage complicating cervical durotomy and revision C1-C2 fusion is reported. There has been only one report on cerebellar hemorrhage after cervical durotomy. Summary of Background Data The patient became comatose approximately 16 hours after surgery. According to a review of the recovery room records, the patients cerebellar hemorrhage probably occurred some time within the first 10 hours after the procedure and not during the operation. Methods The authors reviewed reports on complicated cerebellar hemorrhage, and the causative factors were studied. Conclusion Postoperative drainage of cerebrospinal fluid, especially when negative pressure is applied, may play a role in the occurrence of cerebellar hemorrhage.

Spontaneous Intracranial Hypotension Successfully Treated by Epidural Patching With Fibrin Glue

We report a case of spontaneous intracranial hypotension due to a cerebrospinal fluid leak at the C2 level, which was successfully treated by epidural fibrin glue patching. Epidural blood patching was performed twice, first with 6 mL of autologous blood and then with 10 mL, but the intracranial hypotension was unresponsive. Although successful treatment of postdural puncture headache and persistent leak after intrathecal catheterization by epidural patching with fibrin glue has been reported, fibrin glue has not been previously applied in spontaneous intracranial hypotension. Our observation suggests that epidural patching with fibrin glue should be considered in patients with spontaneous intracranial hypotension, if epidural blood patching fails to resolve the symptoms.

Ruptured dissecting aneurysm of the vertebral artery revealed by repeat angiography.

A case of subarachnoid hemorrhage caused by the rupture of a dissecting aneurysm of the vertebral artery is reported. The initial angiogram was normal, and repeat angiography carried out 12 days later revealed a dissecting aneurysm of the right vertebral artery. This angiographic change seems to be due to the progression of minimal dissection that was not found at the time of first angiogram.

Dural caroticocavernous fistula with both ophthalmic arteries arising from middle meningeal arteries.

Abstract A 60-year-old woman presented with a dural caroticocavernous fistula (CCF) in whom both by ophthalmic arteries arose from the middle meningeal arteries instead of from the internal carotid arteries. Transarterial embolisation of the CCF was contraindicated because of the risk of blindness. Transvenous coil embolisation was therefore performed. Bilateral origin of the ophthalmic artery from the middle meningeal artery is extremely rare.

L-type high voltage-gated calcium channels cause an increase in diazepam binding inhibitor mRNA expression after sustained exposure to ethanol in mouse cerebral cortical neurons

Mechanisms for increase in diazepam binding inhibitor (DBI) mRNA expression after sustained exposure to ethanol (EtOH) were investigated. Increases in 30 mM KCl-induced [45Ca(2+)] influx and DBI mRNA expression after EtOH (50 mM) exposure for 3 days were completely abolished by nifedipine, but not by omega-agatoxin VIA and omega-conotoxin GIVA. These results indicate that EtOH-induced increase in DBI mRNA expression is mediated via increased Ca(2+) entry through up-regulated L-type high voltage-gated calcium channels.

Central diabetes insipidus caused by nonspecific chronic inflammation of the hypothalamus: case report

A case of central diabetes insipidus (DI) caused by non-specific chronic inflammation of the hypothalamus was reported. As the central DI was associated with acute posterior multifocal placoid pigment epitheliopathy with an immunogenic predisposition, and human leukocyte antigen class I antigen A2 and class II antigen DR4 were found, it might be a case of autoimmune reaction.

Primary squamous cell carcinoma of the brain. A rare autopsy case

In the present study, a rare autopsy case of primary squamous cell carcinoma of the brain is described. The patient was a 49‐year‐old man who showed brainstem symptoms and signs. These included oculomotor, abducens and facial palsies, dysphagia, dysarthria, and long tract signs such as quadriplegia with Babinskis signs during the 3‐year and 6‐month course of his illness. Neuropathologically, poorly differentiated squamous cell carcinoma was seen in the pons, medulla oblongata, part of the midbrain and spinal cord, the base of the cerebellum, the hypothalamus, the optic chiasm, and the left parahippocampal gyrus. The base of the pons and medulla oblongata were extensively destroyed by tumor cells. The relevant literature regarding primary squamous cell carcinomas of the brain was reviewed, and the characteristic features of this rare condition were discussed.

The cerebral circulation in cases of carotid cavernous fistula

SummaryTen patients with carotid cavernous fistula (CCF) were reviewed. Single photon emission computed tomography (SPECT) for regional cerebral blood flow (rCBF) study was performed in six patients with fast flow shunt. Five of these six patients with fast flow shunt angiographically demonstrated cortical venous drainage, and two of these patients suffered intracerebral hemorrhage. The rCBF decreased in the region demonstrating the cortical venous drainage in five patients, and in one patient the angiography demonstrated arterial steal and the rCBF decreased in a part of the ipsilateral cerebral hemisphere. SPECT proved to be useful in assessing the cerebral circulation in cases of CCF.

Effect of STA-MCA Anastomosis on Regional Cerebral Blood Flow in Ischemic Cerebrovascular Disease

The long-term effects of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis on regional cerebral blood flow (rCBF) were evaluated in 54 patients with ischemic cerebrovascular disease who were operated on in the chronic stage. rCBF was measured by the Xe-133 inhalation method using initial slope index. The mean follow-up period was 26 months. In cases of major artery occlusion without infarction in the cortex, mean hemispheric CBF (mCBF) in the affected side increased and laterality (the difference in mCBF between the hemispheres) was reduced significantly 3 months after surgery. The improvement in mCBF was sustained for up to 3 years. In cases of major artery occlusion with infarction in the cortex, mCBF did not increase but laterality decreased soon after surgery and the reduction was sustained for a long period. In patients with major artery stenosis, mCBF decreased significantly within 3 months of surgery and then increased gradually, eventually approaching the preoperative levels. Laterality was unchanged. These observations indicate that, in selected cases, STA-MCA anastomosis confers long-term hemodynamic improvement in patients with ischemic cerebrovascular disease.