Yoshifumi Hirata

Intracerebral venous angioma with arterial blood supply: A mixed angioma

An 18-year-old man was operated upon with a diagnosis of intracerebral hematoma. Although the angiogram of the right carotid artery demonstrated the characteristic umbrella appearance of the venous angioma in the parietal lobe, fine arterial branches supplying the vascular malformation were noted in the preoperative angiogram. At the operation, no nidus was found, and delicate angiomatous networks with red veins were observed around the hematoma cavity. Histologic examination of the angiomatous network proved it to be an arteriovenous malformation. It was a mixed angioma, which combined venous angioma and arteriovenous malformations. Clinical, angiographic, and pathological features of intracerebral venous angiomas with arterial components were reviewed from the literature.

Occlusion of the internal carotid artery after radiation therapy for the chiasmal lesion

SummaryOcclusion of the intracranial portion of the internal carotid artery were encountered in two cases with suprasellar tumours, who had received irradiation therapy previously and shown excellent clinical improvement postoperatively.Clinical features and the angiographic characteristics were analysed in these two cases and the restults were compared with reports in the literature. The occlusive effect of radiation on the arterial wall was conceived as the cause of carotid obstruction. In order to avoid this side effect of radiation therapy, especially for brain tumours of low malignancy in childhood, careful estimation of the radiation dose should be required and cerebral angiographic follow-up during and after the treatment with radiation is indicated, particularly when the patient develops cerebral transient ischaemic symptoms.

Hemangioma of the temporalis muscle: Case report and review of the literature

A 51 year-old man presented with a 10-year history of a painless, slowly growing mass (35 x 25 x 15 min) in the right temporal fossa. The T1-weighted image on magnetic resonance imaging demonstrated a partial, low-signal intensity lesion with high intensity in the lower part and significant enhancement with contrast medium. The tumor, which lay within the temporal muscle, was totally excised, and histological examination confirmed the lesion to be an intramuscular, cavernous type of hemangioma. The therapeutic options are described.

Predictive assessment of shunt effectiveness in patients with idiopathic normal pressure hydrocephalus by determining regional cerebral blood flow on 3D stereotactic surface projections

SummaryBackground. The regional cerebral blood flow (rCBF) and cerebral metabolism in patients with idiopathic normal pressure hydrocephalus (iNPH) remain to be studied in detail.Purpose. Using single-photon emission computed tomography (SPECT), we compared the characteristic rCBF patterns in iNPH patients who did, or did not, respond to shunt operations.Materials and Methods. We studied 24 consecutive iNPH patients: 14 men and 10 women aged 68 to 88 years (mean 77.5 years). Using the Japanese normal pressure hydrocephalus grading scale, they were divided into responders and non-responders to shunt operations. Follow-up ranged from 10 to 36 months (mean 25 months). We obtained baseline single-photon emission computed tomography (SPECT) data on three-dimensional stereotactic surface projections (3D-SSP) before and after shunt operations, and compared rCBF in responders and non-responders.Results. On statistical maps, responders manifested significantly lower rCBF in the basal frontal lobes and cingulate gyrus (anterior-dominant).Conclusions. The preoperative measurement of rCBF by 3D-SSP SPECT may help to identify iNHP patients expected to exhibit a good response to shunt operations.

Syringomyelia associated with a foramen magnum meningioma

In a 14-year-old boy with a meningioma at the foramen magnum extending to C-2, cervical syringomyelia was found on metrizamide computed tomographic myelography. The mechanism of syrinx enhancement on delayed computed tomographic scanning was considered to be due to transneural passage of metrizamide into the spinal cord. Long-standing spinal block may be responsible for development of syringomyelia. Syringomyelia associated with spinal extramedullary tumors was reviewed in the literature.

Apraxia of lid opening is alleviated by pallidal stimulation in a patient with Parkinson’s disease

Apraxia of lid opening (ALO) is a syndrome characterized by a non‐paralytic inability to open the eyes at will in the absence of visible contraction of the orbicularis oculi muscle. Here we report that globus pallidus internus deep brain stimulation on the right side markedly alleviates ALO as well as gait freezing in a patient with Parkinson’s disease.

Posteroventral pallidotomy in a patient with parkinsonism caused by hypoxic encephalopathy

We report a patient with a hypokinetic-rigid form of parkinsonism caused by hypoxic encephalopathy, in whom parkinsonian symptoms were markedly alleviated by staged bilateral posteroventral pallidotomy.

Paradoxical Worsening of Spasticity and Pain in the Lower Extremities After Increasing the Dose of Intrathecal Baclofen—Case Report

Objectives:  Some patients with spasticity and pain in the extremities fail to respond to increases in the dose of intrathecally delivered baclofen.

Analysis of Cerebral Blood Circulation using Intravenous Digital Subtraction Angiography

Digital subtraction angiography with intravenous injection of contrast medium was used to assess 10 patients with ischemic disease. The time-density curve (TDC) was evaluated for its usefulness in analyzing brain blood circulation (dynamics). Such other parameters as peak time (PT), mean transit time (MTT), and mode of transit time (MOTT) were also assessed. Particular attention was paid to high convexity, watershed, and perforator areas of the middle cerebral artery, which are regions of interest in the bilateral hemispheres. The dynamics of blood circulation demonstrated by this method were compared with those demonstrated by single photon emission computed tomography (SPECT). In patients with carotid artery stenosis, the TDC at the convexity area on the affected side showed both a gentle upward slope and a slow downward slope, and all parameters (PT, MTT, MOTT) were prolonged. After endarterectomy, the delay in all parameters decreased and the laterality of the TDC diminished. In patients with middle cerebral artery occlusion, the TDC at the convexity area on the affected side showed delay of attenuation, and all parameters were prolonged. After superficial temporal artery-middle cerebral artery anastomosis, the peak on the operated side was higher than that on the unaffected side and prolongation of MTT and MOTT on the affected side was decreased. In cases of moyamoya disease, none of the parameters could be calculated because the TDC showed no downward slope. In all of the evaluable cases, TDC data were superior to SPECT determinations in detecting laterality of the circulation. These results indicate that this method accurately demonstrates laterality of circulation time and volume as well as the degree of collateral circulation. The TDC and other parameters appear useful in determining whether or not surgery is indicated and in estimating the postoperative circulation in patients with ischemic disease.

Effect of Sodium Ozagrel and Nizofenone in the Treatment of Patients with Cerebral Vasospasm after Subarachnoid Hemorrhage

One hundred twenty six patients with subarachnoid hemorrhage due to ruptured intracranial aneurysm were admitted to our service between June 1988 and November 1989. Of these, 79 patients were treated with sodium ozagrel, thromboxane A9 synthetase inhibitor, or nizofenone, cerebral protector for ischemic cerebral damage. The effects were evaluated by the outcome of patients, incidence of symptomatic vasospasm and fatal vasospasm. Sodium ozagrel improved the outcome of patients and reduced the incidence of fatal vasospasm; however, it did not reduce the incidence of symptomatic vasospasm. Nizofenone was effective as well, but less so than sodium ozagrel. These results suggested that both drugs were effective in the treatment of delayed ischemic neurological deficits (DIND) due to cerebral vasospasm after subarachnoid hemorrhage.