Tsutomu Nagamitsu

Cerebrospinal fluid and plasma concentrations of nitric oxide metabolites in postoperative patients with subarachnoid hemorrhage.

ObjectiveTo measure cerebrospinal fluid and plasma concentrations of nitrate and nitrite as indicators of nitric oxide production in adults after subarachnoid hemorrhage (SAH). DesignA prospective, clinical study. SettingMultidisciplinary intensive care unit. PatientsNine patients (three males and six females, aged 29-64 yrs) with aneurysm-induced SAH were studied. Glasgow Coma Scale score on admission ranged from 9 to 15. Ruptured aneurysms were clipped within 72 hrs of ictus, and then conventional hypervolemic, hemodilution, and induced hypertension methods were applied. InterventionsNone. Measurements and Main Results Nitrate and nitrite concentrations of patients were examined sequentially by a capillary zone electrophoresis every day for 13 days. As a control group, cerebrospinal fluid was sampled from patients (n = 9, six males and three females, aged 30-60 yrs) without neurologic disorders who underwent spinal taps for spinal anesthesia, and plasma from healthy human volunteers (n = 43, 21 males and 22 females, aged 23-49 yrs). There were no significant differences over time in cerebrospinal fluid nitrate concentrations after SAH. Concentrations of cerebrospinal fluid nitrate after SAH were increased compared with control values. Plasma nitrate concentration was decreased compared with control values, but the value on day 14 was increased significantly (p < .05) compared with those during days 2–11. Plasma and cerebrospinal fluid nitrite concentrations after SAH were similar to those in control subjects. Similar concentrations of nitric oxide metabolite in plasma and cerebrospinal fluid were observed between the patients with and without symptomatic vasospasm. ConclusionThe increase of cerebrospinal fluid nitrate after SAH may attribute to the endogenous nitric oxide production in the injured brain.

A case of Walker-Warburg syndrome with uncommon findings Double cortical layer, temporal cyst and increased serum IgM

We report a Japanese boy with the Walker-Warburg syndrome. He had typical clinical features, including type II lissencephaly, congenital muscular dystrophy and an ocular abnormality associated with previously undescribed findings, a double cortical layer and an isolated cyst evident on magnetic resonance imaging, and an increased level of serum IgM. We speculate that the inner layer of the cortices in this case represents a layered heterotopia under the cerebral cortex.