Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 09/2012; 70(11):e674-8. · 1.58 Impact Factor
ABSTRACT: A 31-year-old man presented with bilateral unruptured vertebral artery (VA) dissections. The temporal course of the dissected arteries was successively evaluated using brain surface imaging modality basi-parallel anatomical scanning (BPAS) magnetic resonance (MR) imaging in combination with the conventional modalities of MR angiography and three-dimensional computed tomography (3D-CT) angiography. Initially, BPAS-MR imaging clearly demonstrated bilateral fusiform dilatations of the arterial wall, whereas MR angiography and 3D-CT angiography showed irregular, dilated, or interrupted inner contour of the arteries. Finally, BPAS-MR imaging demonstrated resolution of both aneurysms, and MR angiography demonstrated obstruction of the left VA and normal contours of the right VA. Combination of diagnostic tools such as BPAS-MR imaging and MR angiography is useful for evaluating the exact nature of dissected arteries and determining the temporal course.
Neurologia medico-chirurgica 01/2011; 51(8):575-8. · 0.61 Impact Factor
ABSTRACT: A 37-year-old woman with congenital afibrinogenemia presented with chronic subdural hematoma (CSDH) manifesting as severe headache, nausea, and somnolence after a minor head trauma. Brain computed tomography scans showed a right subdural hematoma associated with midline shift. Laboratory studies showed prolongation of prothrombin time, activated partial thromboplastin time, and undetectably low level of fibrinogen. Until the present episode, she had received plasma-derived fibrinogen concentrate around menstruation and pregnancy. She had also suffered from spinal cord infarction due to vertebral artery occlusion. Burr-hole evacuation and drainage of CSDH was successfully performed using fibrinogen concentrate. The development of CSDH with afibrinogenemia is very rare. Although the past repeated administrations of fibrinogen concentrate were suspected to generate CSDH, paradoxical thrombotic complications caused by upregulation of prothrombin activation, thrombin generation, and growth factors released from platelets might be related to the development of CSDH with congenital afibrinogenemia.
Neurologia medico-chirurgica 01/2011; 51(11):780-3. · 0.61 Impact Factor
ABSTRACT: The significance of the extent of surgical resection on the prognosis of glioma still remains controversial even at the present
time with modern computerized surgical facilities. Low-grade tumors are in general relatively slow-growing and most tumors
remain stable for a quite long period even after partial resection with/without radiotherapy. Glioblastoma multiforme, the
most malignant histological type of gliomas, on the other hand, is highly invasive and virtually incurable even after removal
of the whole tumor mass with contrast-enhancement on MRI. The median survival of the patients with glioblastoma is generally
less than one year from the time of diagnosis and this has not significantly improved for more than three decades despite
continuous refinement of treatment strategies. Since the tumor recurrence usually occurs from the resection border where some
residual tumor cells have been left behind and distant metastasis is seldom observed in gliomas, local tumor control would
prolong the survival of those patients. Continuous efforts have been paid to develop novel strategies and some promising experimental
data have been demonstrated. Therefore, when the effective adjuvant therapies after surgical removal become available, the
extent of surgical removal would become one of the most important prognostic factors, which is already the case in medulloblastoma.
In the present paper, current standard therapies for gliomas are reviewed and newly developed methods to improve extent of
tumor removal are introduced.
12/2005: pages 22-28;
ABSTRACT: Although cognitive impairments have been observed after subarachnoid hemorrhage (SAH), little is known about their neurobiological bases. To examine cholinergic function in such patients, we used a known test for Alzheimer's disease based on an exaggerated pupil dilation response to a cholinergic antagonist, tropicamide (the tropicamide drop test).
Seventeen patients who were treated surgically after aneurysmal SAH were divided into two groups on the basis of their scores on the Mini-Mental State Examination (MMSE): Group A (MMSE > or =28) and Group B (MMSE < or =27). The mean interval of time between surgery and administration of the MMSE was 4.7 +/- 2.1 years for Group A and 4.2 +/- 1.3 years for Group B. The tropicamide drop test was performed within 1 month after the MMSE for each patient. After measurement of the baseline pupil diameter (R1, right pupil size: L1, left pupil size), one drop of 0.01% tropicamide was applied to the right eye and physiological saline to the left eye. Pupil diameter (R2, right pupil size; L2, left pupil size) was then remeasured. Data were represented as the dilation ratio of the right pupil (R2/R1) and as the relative dilation ratio of the right pupil to that of the left pupil (R2L1/R1L2).
The mean dilation ratio of the right pupil (R2/R1) was higher in Group B (1.13 +/- 0.09) than in Group A (1.07 +/- 0.11), although the difference did not reach statistical significance (P = 0.18). The relative dilation ratio (R2L1/R1L2) was significantly higher in Group B (1.41 +/- 0.36) than in Group A (1.06 +/- 0.20) (P < 0.05).
We determined cholinergic dysfunction in patients with cognitive impairment after SAH on the basis of the pupillary response to tropicamide. The results provide an insight into the pathophysiology of cognitive impairments after SAH, which might lead to future treatment strategies.
Neurosurgery 10/2002; 51(4):944-7; discussion 947-8. · 2.79 Impact Factor