[Show abstract][Hide abstract] ABSTRACT: A patient with moyamoya disease presenting with subarachnoid hemorrhage (SAH) is reported. A 38-year-old Japanese woman developed a sudden onset headache and nausea during hospitalization for a cerebral infarct in the right frontal lobe. CT scan showed SAH in the left frontal sulci. Cerebral angiogram showed stenosis of the distal bilateral internal carotid arteries with moyamoya vessels, and significant transdural anastamoses from the left external carotid artery to cortical arteries on the left frontal cortex. The patient was kept normotensive and underwent a right-sided surgical revascularization procedure, remaining well for three years. SAH not due to ruptured aneurysm in moyamoya disease is rare. The cause of the SAH was thought to be disruption of the transdural anastomotic vessels. Recognition of these fragile vessels in moyamoya disease is essential.
No preview · Article · Feb 2006 · Journal of Clinical Neuroscience
[Show abstract][Hide abstract] ABSTRACT: In neutron capture therapy, the therapeutic effect of the boron compound is based on alpha particles produced by the B(n, alpha) reaction while with the gadolinium compound the main radiation effect is from gamma rays derived from the Gd(n, gamma) reaction. The uptake and distribution within the tumor may be different among these compounds. Thus, the combination of the boron and gadolinium compounds may be beneficial for enhancing the radiation dose to the tumor. Chinese hamster fibroblast V79 cells were used. For the neutron targeting compounds, 10B (BSH) at 0, 5, 10, and 15 ppm, and 157Gd (Gd-BOPTA) at 0, 800, 1600, 2400, 3200, and 4800 ppm, were combined. The neutron irradiation was performed with thermal neutrons for 30 min. (neutron flux: 0.84 x 10(8) n/cm2/s in free air). The combination of the boron and gadolinium compounds showed an additive effect when the gadolinium concentration was lower than 1600 ppm. This additive effect decreased as a function of gadolinium concentration at 2400 ppm and resulted in no additive effect at more than 3200 ppm of gadolinium. In conclusion, the combination of the boron and gadolinium compounds can enhance the therapeutic effect with an optimum concentration ratio. When the gadolinium concentration is too high, it may weaken the boron neutron capture reaction due to the high cross-section of gadolinium compound against neutrons.
Full-text · Article · Apr 2005 · Journal of experimental & clinical cancer research: CR
[Show abstract][Hide abstract] ABSTRACT: Spontaneous intracerebral hematomas usually produce the sudden onset of devastating neurological symptoms. We describe a case showing slowly progressive clinical symptoms followed by a sudden deterioration caused by two different types of intracerebral hematomas coexisting in the adjacent area. A 72-year-old female with a 2-year history of Alzheimer's disease and a 3-month history of occasional headache and vomiting was admitted after she experienced the sudden onset of right hemiparesis and a speech disturbance. Neuroradiological examinations demonstrated two different types of intracerebral hematomas coexisting in the left temporal lobe. The patient underwent a left frontotemporal craniotomy. A solid hematoma was found immediately below the cortex and a large hematoma cavity, which contained degraded bloody fluid, was found below the solid hematoma. Histological study demonstrated an arteriovenous malformation (AVM). The AVM may have been responsible for the pathogenesis of these two different types of intracerebral hematomas. Initially, a silent intracerebral hemorrhage from the AVM and liquefaction of the hematoma probably formed the cavity and repeated small subclinical hemorrhages into the cavity during a prolonged period of time may have caused the growth of the inner hematoma. The sudden rupture of the AVM most likely caused the outer solid hematoma, resulting in the abrupt onset of hemiparesis and speech disturbance. This is the first case to demonstrate two different types of intracerebral hematomas coexisting in the adjacent area. A possible mechanism for this rare condition is discussed. S pontaneous intracerebral hematomas are usually sec ondary to systemic arterial hypertension and pro duce the sudden onset of devastating neurological symptoms. In contrast, another type of intracerebral he-matoma producing stable or slowly progressive neurologi-cal deficits has been reported. 5,21 We present a case show-ing slowly progressive clinical symptoms, which went un-treated, followed by a sudden deterioration. Neuroradiological studies demonstrated two different types of intracerebral hematomas coexisting in the left temporal lobe. A possible mechanism for this rare condition is dis-cussed.
[Show abstract][Hide abstract] ABSTRACT: The indications and timing of treatment, as well as the best treatment method for traumatic central cord syndrome (CCS), remain controversial. The aims of this study are to determine the prognostic factors of traumatic CCS and to determine appropriate surgical indications.
We reviewed the clinical and radiological data of 47 patients with this syndrome. The data collected included age, neurological status as measured on a scale defined by the Japanese Orthopaedic Association (JOA), anteroposterior (AP) diameter of the spinal canal on computed tomography, signal intensity change of the spinal cord on T2-weighted magnetic resonance imaging (MRI), associated spinal diseases, and the type of treatment received. The correspondence between the clinical and radiological findings and the neurological outcome was investigated.
The patient's age, JOA score on admission, signal intensity change of the spinal cord on MRI, and associated spinal diseases were not significant in predicting the patient's recovery. On the other hand, the AP diameter of the spinal canal (P = .0402) and the interval between injury and surgery (P < .0001) were factors predictive of excellent recovery. In the surgical treatment group, timely surgery was found to improve the outcome, while conservative treatment did not improve the outcome of patients with a low JOA score, a relatively small AP diameter of the spinal canal, or a positive signal intensity change of the spinal cord on T2-weighted MRI.
The AP canal diameter of the spinal canal and the interval between injury and surgery may be reliable predictors of excellent recovery in patients with CCS. We recommend timely surgery, preferably within 2 weeks of injury, to achieve a better functional outcome in selected patients.
No preview · Article · Mar 2005 · Surgical Neurology
[Show abstract][Hide abstract] ABSTRACT: Purpose: This work was aimed at quantification of lactate concentration using proton MR spectroscopy (MRS). We carried out a basic study to clarify the characteristics of signal change and T2 relaxation time of lactate that occur by J coupling in point resolved spectroscopy (PRESS) sequence. Materials and Methods: Proton MRS was done for a water phantom containing 10 mmol/L creatine and lactate on a clinical 1.5 T MR system by using an asymmetric PRESS sequence. The coupling constant J was 7.35 Hz. In acquisitions, TE was varied from 68 ms up to 544 ms, with an increment of 68 ms (1/2J) and TR was fixed to 10000 ms. Results: The shape and signal intensity of the lactate signal vary depending on its phase. The lactate signal intensity at TE 272 ms was higher than at TE 136 ms despite the longer TE. T2 relaxation times of lactate in the negative in-phase (TE 136 ms, TE 408 ms) and positive in-phase (TE 272 ms, TE 544 ms) were 1033 ms and 1042 ms, respectively (no significant differences), so that when the same phase was used, regardless of the phase condition, T2 relaxation behavior was not different. We considered that our results included over expression and loss of lactate signal depending on the phase. Conclusions: For evaluation of the lactate peak, we recommend the use of the positive in-phase signal because it is larger than the negative in-phase signal. The influence of the asymmetric PRESS sequence, which may cause loss and over expression of lactate signal, should be considered in the calculation of the quantification. The T2 relaxation time should be also considered in the calculation of the lactate value since it affects the value considerably.
No preview · Article · Feb 2005 · Igaku butsuri: Nihon Igaku Butsuri Gakkai kikanshi = Japanese journal of medical physics: an official journal of Japan Society of Medical Physics
[Show abstract][Hide abstract] ABSTRACT: Autosomal dominant polycystic kidney disease (PKD) is a hereditary disorder characterized by bilateral multiple renal cysts and early onset chronic renal failure. PKD patients tend to suffer their subarachnoid hemorrhage at a younger age. Unruptured aneurysms in PKD patients are not always innocuous, and proactive treatment has been indicated for these lesions. However, the management of PKD patients undergoing unruptured cerebral aneurysm surgery has been documented on only a few occasions. The purpose of this study was to better define the management of unruptured cerebral aneurysms in patients with PKD.
We present a retrospective review of the management of unruptured cerebral aneurysms in 16 patients with PKD. Eight patients were maintained through chronic hemodialysis whereas the remaining 8 patients did not require hemodialysis, at the time of treatment of their cerebral aneurysms. The mean follow-up period was 24 months.
In the nonhemodialysis patients prophylactic hemodialysis was routinely performed after cerebral angiography to prevent deterioration of the pre-existing renal dysfunction. Microsurgical clipping of the aneurysm was performed in 15 patients (7 nonhemodialysis and 8 hemodialysis patients) and intravascular coil embolization was performed in 1 nonhemodialysis patient. One nonhemodialysis patient who underwent microsurgical clipping required a temporary hemodialysis after surgery, but the patient was not shifted to chronic hemodialysis. No patients developed postprocedural complications, and each showed an excellent recovery.
PKD patients with unruptured cerebral aneurysms can be safely treated with an appropriate treatment strategy including the use of prophylactic hemodialysis.
No preview · Article · Jan 2005 · Surgical Neurology
[Show abstract][Hide abstract] ABSTRACT: Brown-Sequard Syndrome (BSS) caused by cervical spondylosis (CS) is rare. About 70% of patients with CS presenting with BSS show lesion-dermatome discrepancy, which may be due to spinal cord lamination. From the clinical point of view, this discrepancy should be carefully evaluated and these patients should be treated as an emergency.
No preview · Article · Dec 2004 · Journal of Clinical Neuroscience
[Show abstract][Hide abstract] ABSTRACT: A 69-year-old man was admitted to our hospital with progressive numbness in both feet and gait disturbance. MR imaging revealed a large cervical disc herniation resulting in significant spinal cord compression with hyperintensity of the spinal cord on T2-weighted images at C-5/6. Immediately after undergoing anterior cervical discectomy, the patient developed severe weakness of his left hand and lower extremities. MR imaging obtained 5 days after surgery revealed a long segment hyperintensity between C-3 and T-2 on T2-weighted images. This long segment hyperintensity disappeared after 2 weeks of steroid administration. We suspect that the persistent, localised, patchy C-5/6 cord hyperintensity represents spinal cord degeneration due to ischaemia and trauma resulting from the disc herniation. However, the transient long segment hyperintensity may represent oedema, probably due to minor trauma of an already compromised cord, during the decompression surgery. Clinicians should be aware that even careful surgery can result in a significant change in radiological studies and neurological condition.
No preview · Article · Dec 2004 · Journal of Clinical Neuroscience
[Show abstract][Hide abstract] ABSTRACT: There are no reports of hydrocephalus following radiosurgery for a meningioma. We report on a case where gamma knife therapy for a 4 cm diameter right cerebellopontine meningioma accelerated hydrocephalus three months post treatment. Examination of the cerebrospinal fluid (CSF) revealed a high protein level and thus, CSF malabsorption and CSF obstruction might have occurred after the radio surgery. It is important to consider this pathology, and the need for long term follow up. (C) 2004 Published by Elsevier Ltd.
No preview · Article · Oct 2004 · Journal of Clinical Neuroscience
[Show abstract][Hide abstract] ABSTRACT: A 23-year-old woman presented with ipsilateral hemiparesia due to rupture of a left occipital arteriovenous malformation (AVM). Emergency decompression (the onset-operation interval was 46 minutes,) was carried out and the patient could leave the hospital upon recovery without neurological deficits. In general, Kernohan's phenomenon is caused by the gradual displacement of the cerebral peduncle against the tentorial edge caused by compression by the contralateral mass. This phenomenon is very rare among the cases with spontaneous intracranial hemorrhage and only three cases including the present one have been reported in the literature. In all cases the onset-operation intervals of were very short. Kernohan's phenomenon associated with a ruptured AVM is a rare condition and emergency decompression is required.
No preview · Article · Jun 2004 · Journal of Clinical Neuroscience
[Show abstract][Hide abstract] ABSTRACT: Subdural hygroma is a frequent delayed complication of head trauma. Most hygromas are clinically 'silent' and a few cases have shown slow deterioration in the chronic stage. We report a case of subdural hygroma showing unique radiological findings and rapid deterioration. A 74-years-old female presented with a mild headache and consciousness disturbance after head injury. Computed tomography showed a midline shift as a result of two components piling up in the subdural space; the outer components showed low density, the inner components high density. Magnetic resonance imaging demonstrated that these two subdural components were subdural hygroma and subarachnoid hematoma. Simple burr hole irrigation, rather than large craniotomy, was thought to be more appropriate treatment to reduce the mass effect. Simple burr hole irrigation was performed to remove the subdural hygroma and the patient showed an excellent recovery. Careful examination of the radiological findings prevented an unnecessary procedure in this case. A possible mechanism of this phenomenon is discussed.
No preview · Article · May 2004 · Journal of Clinical Neuroscience
[Show abstract][Hide abstract] ABSTRACT: Natural killer (NK) cells are highly efficient in the cellular immune response against malignant tumors without restriction of major histocompatibility complex. However clinical studies using autologous NK cells have been reported in only a very limited number of cases, due to the fact that selective NK expansion is difficult to achieve in this patient population. Here, we report the results of adoptive immunotherapy in patients with recurrent malignant gliomas using autologous NK cells that were expanded ex vivo by a novel method.
Peripheral blood mononuclear cells (PBMCs) were prepared from patients with malignant gliomas, and were co-cultured with an irradiated human feeder cell line (HFWT) in RHAM-alpha medium supplemented with 5% autologous plasma and interleukin-2. The resulting NK cell-rich effector cells were injected into 9 patients (16 courses) with recurrent malignant glioma (6 cases of WHO grade-3 glioma and 3 cases of grade-4 glioma).
The mean frequency of NK cells among lymphocytes was 82.2 +/- 10.5%. A combination of focal and intravenous injections was peformed in 10 courses. Intravenous injection alone was performed in 6 courses. Further, intravenous injection of low-dose interferon beta (6x10(6) IU/week) was performed as an adjuvant therapy in all courses to achieve maximum benefit for enrolled patients. Clinical evaluation demonstrated 3 PR, 2 MR, 4 NC and 7 PD in a total of 16 courses of treatment. Severe neurological toxicity was not observed in any of the patients.
It was demonstrated that NK cell-rich effector cells were expanded ex vivo from PBMCs in all nine cases of recurrent malignant glioma and that NK cell therapy was safe and partially effective in patients with recurrent malignant gliomas.
Full-text · Article · May 2004 · Anticancer research
[Show abstract][Hide abstract] ABSTRACT: Of 175 patients with 181 aneurysms initially treated with Guglielmi Detachable Coils (GDC), 25 were retreated. All retreatments except one were performed on previously ruptured aneurysms. Thirteen aneurysms were retreated because of recurrence, and 12 aneurysms were retreated to complete initial insufficient embolization. Sixteen patients underwent re-embolization and 9 patients were operated upon surgically. No complications related to the retreatment were experienced. We consider that repeat embolization should be attempted before considering surgical treatment in case that additional therapy is required. However, it is difficult to retreat aneurysms having wide necks. In regard to surgical clipping, aneurysms without a coil in the neck are easier to treat with primary clipping, whereas aneurysms with a coil mass in the neck are difficult to surgical clip. We have never used temporary clipping and coil extraction if the distance between the coil and the parent artery was wider than 2 mm. Emerging new embolic agents or devices and technical improvement might decrease the need for retreatment and increase long-term efficacy after endovascular treatment.
Preview · Article · Mar 2004 · Interventional Neuroradiology
[Show abstract][Hide abstract] ABSTRACT: Primary or metastatic cerebral angiosarcoma is extremely rare, and only limited cases have been reported. The authors here describe a case of angiosarcoma, which was initially identified and diagnosed by the cerebral metastatic lesion; later examinations suggested that the primary site was the abdominal aorta.
A 53-year-old man, who had suffered an abdominal aortic aneurysm 2 months earlier, experienced a sudden onset of left-sided hemifacial convulsion and dysarthric speech. Computed tomography (CT) showed a hemorrhagic mass lesion with perifocal edema in the right frontal lobe. Magnetic resonance imaging (MRI) showed a regionally marked hypointensity in the mass lesion on both T1- and T2-weighted images, which might suggest hemosiderin deposition. The tumor was removed in its entirety. Pathologic examination revealed an old hematoma with a hemosiderin deposit containing markedly atypical tumor cells, and angiosarcoma was diagnosed. Resection of the abdominal aortic aneurysm and iliac bone biopsy were performed and angiosarcoma was recognized in each surgical specimen. Based on clinical and pathologic findings, the primary site was considered to be the abdominal aorta.
Clinicians should be aware of this rare histologic type of tumor. Unique MRI findings such as those obtained in our case might be useful for differentiating this condition from other intracranial neoplasms.
No preview · Article · Feb 2004 · Surgical Neurology
[Show abstract][Hide abstract] ABSTRACT: Combined therapy with a fixed-tumor cell vaccine and intratumoral injection of NK cells induced strong tumor regression of rat glioma. Rat 9L glioma cells were inoculated into syngeneic male rats at the flank (subcutaneous tumor model) or at the basal ganglia of the right hemisphere (intracranial tumor model). Rats were intradermally injected three times with vaccine comprising fixed 9L cells, IL-2- and GMCSF-microparticles, and tuberculin prior to (protective studies) or after (therapeutic studies) challenge with live 9L cells. In the protective studies, the vaccine alone achieved significant tumor growth inhibition and elongation of mean life span in both the subcutaneous and intracranial tumor models. No therapeutic effect was observed in the intracranial tumor model with the vaccine alone. However, intratumoral injection of rat NK cells strongly assisted the therapeutic effect of the vaccine in the brain tumor model and resulted in a statistically significant elongation of life span. We propose that intratumoral injection of NK cells may not only kill brain tumor cells directly, but also trigger a strong immune response in the focal lesion of the brain after vaccination.