So Sato

An Attempt to Treat Cerebrovascular ‘Moyamoya’ Disease in Children

Moyamoya formations at the base of the brain are not congenital vascular malformations but represent collateral pathways associated with chronic progressive stenosis of the carotid fork. The authors have studied 44 personal cases, 18 children under 15 years of age, and 26 adults. In children the Moyamoya vessels change through six stages: (1) carotid fork stenosis; (2) progressive carotid stenosis with initial Moyamoya collaterals and dilatations of cerebral arteries; (3) dilatation of Moyamoya collaterals and disappearance of anterior and middle cerebral arteries; (4) thinning of Moyamoya; (5) contraction of Moyamoya and disappearance of posterior cerebral arteries; (6) intracerebral vessels perfused from the external carotid and/or vertebrae. These six stages are not observed in adults. Bilateral cervical perivascular sympathectomy (PVS) was performed in 9 children and superior cervical ganglionectomy (SCG) was added unilaterally in 4 and bilaterally in 3 cases. Angiographic follow-up studies were carried out 1-7 years following surgery. Improvement was observed in most of the cases examined within the first 2 months after surgery. This was not the case in arteriograms performed more than 6 months postoperatively. It would seem that PVS and SCG can improve the progress of Moyamoya vessels but only for a short period of time. Clinical symptoms, however, seem to continue improving over a long period of time. Cerebral blood flow improved 5 weeks following surgery in a 13-year-old boy.

Distributions of heat shock protein (HSP) 70 and heat shock cognate protein (HSC) 70 mRNAs after transient focal ischemia in rat brain

The distribution of heat shock protein (HSP) 70 and heat shock cognate protein (HSC) 70 mRNA after 30 min of middle cerebral artery (MCA) occlusion was investigated in rat brain by in situ hybridization using cloned cDNA probes selective for the mRNAs. While HSP70 mRNA was hardly present at caudate and dorsal hippocampal levels of the sham brain this mRNA was greatly induced in cells of the MCA territory 1 h after reperfusion. Although the maximum amount of induced HSP70 mRNA in the caudate was much smaller than that in the cortex the maximum induction in the caudate (3 h) preceded that in the cortex (8 h). In contrast to the case of HSP70 mRNA, HSC70 mRNA was present in most cells of the sham brain, and was especially dense in hippocampal CA3 cells. Further induction of HSC70 mRNA was observed after reperfusion in the same cell populations, as in the case of HSP70 mRNA. HSC70 mRNA levels were significantly reduced in the caudate at 8 h when small amounts of HSP70 mRNA were still elevated. In the ipsilateral granule cells of the dentate gyrus and hippocampal CA3 cells a slight but significant induction of HSC70 mRNA was observed from 1 h to 1 day, while obvious induction of HSP70 mRNA never occurred. All the induced signals of HSP70 and HSC70 mRNA were diminished or returned to the sham level by 7 days, except for HSC70 mRNA in the caudate. These results are the first observations of the distribution of HSP70 and HSC70 mRNA after transient focal ischemia of rat brain.(ABSTRACT TRUNCATED AT 250 WORDS)

Posttraumatic dissecting aneurysm of the anterior cerebral artery: case report.

A case of cerebral infarction in the territory of the anterior cerebral artery after a minor head injury is reported. It is possible that direct or mechanical damage by the edge of the falx or stretching and shearing of the anterior cerebral artery after an acute shift of the corpus callosum caused the localized lesion of the left anterior cerebral artery. We think that this mechanical injury caused a dissecting aneurysm or a cerebral arterial dissection, which was diagnosed by sequential angiographic changes.

Correlation with superior cervical sympathetic ganglion and sympathetic nerve innervation of intracranial artery-electron microscopical studies

When the superior cervical ganglion was resected in dogs, nerve degeneration in arterial walls began after about 28 h and marked degenerative substance was shown after 40-48 h; after 4 days the small cored vesicles of adrenergic axons disappeared. The same condition was seen after 3 months, but after 6 months the small cored vesicles were again visible. When the middle cerebral artery was examined by separating it into the perforating artery near to the internal carotid artery and the peripheral portion of the middle cerebral artery, degeneration of the nerve fibers of the arterial walls occurred earlier in the more proximal portion. The distribution of adrenergic nerve fibers from the superior cervical ganglion is bilateral in the anterior cerebral artery from the anterior communicating artery to the peripheral region, basilar artery, and vertebral artery, but ipsilateral only in the anterior cerebral artery as far as the anterior communicating artery, middle cerebral artery, posterior communicating artery, posterior cerebral artery and superior cerebellar artery. Degeneration of nerve fibers of the walls of these cerebral arteries was not seen ever after stellate ganglionectomy in both sides.

The new transinsular approach to the hypertensive intracerebral hematoma

A new operative procedure for intracerebral hematoma through the Sylvian fissure and the insula is described, which was used in six cases of hypertensive intracerebral hematoma. The advantage it offers and indication for the use of this procedure are compared with those of the traditional operative methods such as burr hole aspiration and large craniotomy followed by cortex incision.

Lhermitte-Duclos disease associated with Cowden disease

We encountered a patient with Lhermitte-Duclos disease accompanied by Cowden disease, the second reported in Japan. The histological findings are described in detail. It is important to suspect Cowden disease in patients with Lhermitte-Duclos disease. Although Cowden disease is little known, making the diagnosis is very important, because cancer frequently occurs in the patients famility and genetic counseling is necessary.

Isolation and expression of an ischaemia-induced gene from gerbil cerebral cortex by subtractive hybridization

A subtraction cDNA library was made using subtractive hybridization of cDNA libraries constructed from gerbil cerebral cortex of control animals and animals 8 h after 10 min of transient forebrain ischaemia. After differential screening, a cDNA clone (named pGSH3) was isolated as a gene which is expressed only after the ischaemia insult. The cDNA insert of pGSH3 (0.7 Kb) hybridized to 2.8 Kb mRNA of ischaemic cerebral cortex. The gene was normally expressed in a small amount in the cerebellum, kidney, and lung, but was not expressed in the cerebral cortex, heart, liver, or jejunum in a detectable amount. Eight hours after the 10-min transient forebrain ischaemia, the gene expression became prominent in the cerebral cortex, and the amount of the mRNA also increased in the lung and kidney. An analysis of DNA sequence revealed that the pGSH3 insert has a 91.3 per cent homology with a 70-Kd human heat shock protein (HSP70) gene. These results indicate that an ischaemia-induced gene was isolated as a cDNA clone (pGSH3) by subtractive hybridization and differential screening. Expression of the gene was first detected in other organs especially in the kidney and lung after transient forebrain ischaemia.

Ruptured intracerebral abscess

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Pilocytic astrocytoma arising from an area of nudular heterotopia located in the white matter of the temporal lobe: case report

A 16-year-old girl suffering from intractable temporal lobe epilepsy presented with a pilocytic astrocytoma, which occurred in an area of nodular heterotopia located in the white matter of the temporal lobe. The pilocytic astrocytoma appeared to be covered by an area of gliosis, which contained numerous Rosenthal fibers, while in the lesion the pilocytic astrocytoma occupied a small area. The gliosis eventually became a tumor-like lesion. The while matter around the mass was composed of gliosis with nodular heterotopia. Temporal developmental malformation, which was a basic lesion of the patient, might therefore be a precursor lesion of pilocytic astrocytomas.

Spinal malignant lymphoma appearing after radiation and chemotherapy of a pineal region tumor

The occurrence of malignant lymphoma in the pineal region is very rare. We experienced a case of pineal region tumor that was treated by radiation and chemotherapy. After 1 year, the tumor metastasized to the cauda equina and was operated on. The diagnosis was malignant lymphoma. Although the incidence of intracranial malignant lymphoma is known to be on the increase recently, malignant lymphoma should be considered in the differential diagnosis of pineal region tumors.