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Biomedical subjects

H Nakase

Publications and source records attributed to H Nakase.

At least 109 records · Page 6Linked to original sources
PubMed1994

Successful intra-arterial fibrinolysis of the anterior choroidal artery in the acute stage of internal carotid artery occlusion: case report.

A 27-year-old man was admitted to our institution with the sudden development of right hemiparesis and dysarthria beginning an hour after the onset of symptoms on August 9, 1992. The patient was found on admission to have right hemiparesis (2/5), hemihypesthesia, hemianopia, dysarthria; he had transient atrial fibrillation. No abnormalities were detected on computed tomography (CT) scans, and cerebral blood flow studies undertaken following conventional CT scans revealed no low flow regions in the left cerebral hemisphere. But cerebral angiography disclosed an occlusion of the left internal carotid artery with well-developed cross-circulation via the anterior communicating artery and embolus lodged at the level of the anterior choroidal artery. Superselective fibrinolysis using Tracker-18 and 420,000 units of urokinase resulting in complete recanalization of the left anterior choroidal artery without distal migration of the embolus. Immediately after the procedure, his neurologic disturbance underwent complete resolution. In summary, fibrinolysis could be performed but limited to anterior choroidal artery in a case with an occlusion of the internal carotid artery with well-developed cross-flow via the anterior communicating artery; the patient's neurologic condition may deteriorate suddenly if fibrinolysis is incomplete and the embolus migrates to the internal carotid artery.

Acute Disease↗
PubMed1994

Total excision of a thalamic arteriovenous malformation using an orbito-fronto-malar approach: case report.

A 37-year-old woman was admitted to Osaka Neurological Institute after the sudden onset of left hemiplegia, hemihypesthesia, and ipsilateral hemianopia on February 4, 1992. Computed tomography (CT) disclosed the presence of hemorrhage in the right thalamus extending to the ipsilateral internal capsule. Cerebral angiography after CT scanning disclosed the presence of a cerebral arteriovenous malformation (AVM) fed by copsulothalamic and lateral geniculate body arteries originating from the right anterior choroidal artery. She was operated on with removal of the AVM using a right orbito-fronto-malar approach (OFM approach), which did not require transection of the cerebral parenchyma. The anterior choroidal artery could be followed distally from its origin and small feeding branches originating from the parent artery were easily identified, and the cerebral base could be examined in greater detail than with the conventional frontotemporal approach. The nidus could be excised in its entirety without difficulty. Postoperative angiography confirmed total excision of the AVM. She was transferred to another hospital for rehabilitation on April 13, 1992. Motor strength on the left side had improved to 3/5 by that time. The OFM approach appears to be potentially useful for the resection of inferolateral thalamic AVMs, because it does not require corticotomy and feeding branches can be identified and dealt with prior to other surgical manipulations.

Adult↗
PubMed1994

Experimental study of the mechanism of seizure induction: changes in the concentrations of excitatory amino acids in the epileptic focus of the cat amygdaloid kindling model.

L-glutamate (Glu) and L-aspartate (Asp) are two major excitatory amino acids that may be involved in seizure susceptibility and seizure induction. The concentrations of Glu and Asp were measured by microdialysis in the epileptic focus in a cat amygdaloid kindling model. Sequential changes in Glu and Asp (before, during, and after seizure) were measured in the partial seizure (S4) and generalized seizure (S6) groups. By stimulation at and 50 microA below the partial seizure-triggering threshold in the S4 group and the generalized seizure-triggering threshold in the S6 group, Glu was released from the epileptic focus in the S4 group, and both Glu and Asp were released in the S6 group after seizure and stimulation (below threshold), and the amount of Glu and/or Asp release determined seizure induction. Excitatory amino acids may be the trigger of seizure induction in the cat amygdaloid kindling model.

Amygdala↗
PubMed1994

Lateral approach for anterior thoracic spinal lesions.

A lateral approach, consisting of a modified transversectomy, hemilaminectomy, and adequate transversectomy with costectomy of 7-8 cm, was used to treat four cases of anterior or anterolateral thoracic lesions, including two cases of thoracic disc herniations, one of thoracic meningioma, and one of hypertrophic pachymeningitis. All patients presented with gait disturbance, but recovered well postoperatively except for one who needed rehabilitation of the lower extremities. This approach provides a greater access to the anterior thoracic canal, and can achieve effective anterior decompression, and a good outcome for thoracic spinal disease if recognized early.

Female↗
PubMed1994

Vasculopathy of the anterior choroidal artery following intra-arterial chemotherapy--case report.

A 40-year-old male, treated with radiotherapy and supraophthalmic intracarotid artery (ICA) ACNU infusion for glioblastoma in the right occipital lobe, developed cerebral infarction secondary to vasculopathy manifesting as hemiparesis 3 months after a second ICA injection. The initial diagnosis was focal neurotoxicity, but angiography revealed severe vasospasm of the anterior choroidal artery. The symptoms improved gradually with therapy for the vasospasm. Angiography is required to discriminate vasospasm and focal neurotoxicity as a complication of ICA injection of antineoplastic agents.

Adult↗
PubMed1994

Pituitary adenoma invading the skull base--a strategy for skull base surgery.

A strategy for surgical management, including the approach and preoperative evaluation, of pituitary adenoma invading the skull base is described. Preoperative evaluation requires a balloon occlusion test of the internal carotid artery (ICA) to determine tolerance to occlusion. Failure to tolerate occlusion indicates administration of brain protective agents and/or a bypass procedure before tumor removal. The transsphenoidal, pterional, orbitofrontomalar, and infratemporal fossa approaches are all suitable for various tumor locations. A combined orbitofrontomalar and extended frontal approach allows removal of tumor with extensive invasion and is suitable for bypass procedures. Preoperative evaluation of ICA occlusion can prevent development of hemodynamic stroke. We treated five patients with pituitary adenoma invading the skull base, including two primary and three recurrent cases. All symptoms improved, but temporary oculomotor nerve disturbance occurred in three patients and anosmia in one. Reoperations for recurrent pituitary adenomas were effective in reversing the symptoms. No hemodynamic stroke was seen postoperatively. These tumors, except for drug-responsive cases, are indicated for skull base surgery.

Adenoma↗
PubMed1993

Inherited amyloid polyneuropathy type IV (gelsolin variant) in a Japanese family.

We describe a Japanese family with familial amyloid polyneuropathy type IV. The family originates from central Japan, Nagano prefecture, and is unrelated to Finnish or other Caucasian populations. Of 42 members in three generations, 14 individuals (5 men, 9 women) are affected by corneal lattice dystrophy, cranial neuropathy, mild peripheral neuropathy, and skin changes. Polarizing microscopy and immunohistochemistry studies of skin biopsy samples demonstrated abundant amyloid deposits, which bound an antigelsolin monoclonal antibody. Direct sequence analysis of a DNA fragment spanning codon 187 of plasma gelsolin complementary DNA and restriction analysis using a modified polymerase chain reaction demonstrated a single base substitution, guanine to adenine, at nucleotide position 654, which is identical to the mutation in Finnish familial amyloid polyneuropathy type IV. This strongly suggests that the mutation causes the familial amyloid polyneuropathy type IV phenotype regardless of ethnic background.

Adult↗
PubMed1993

Anastomosis of occipital artery to anterior inferior cerebellar artery with interposition of superficial temporal artery. Case report.

A 56-year-old man with vertebrobasilar insufficiency and associated findings including quadriparesis, dysarthria, cerebellar ataxia, nystagmus, and somnolence underwent left occipital artery (OA) to anterior inferior cerebellar artery (AICA) anastomosis with interposition of a superficial temporal artery (STA) graft. This procedure was chosen because cerebral angiograms demonstrated occlusion of the right vertebral artery (V3) and severe stenosis of the V4 segment of the left vertebral artery, with perfusion of the territory of the left posterior inferior cerebellar artery via the ipsilateral AICA, and because dissection of the OA is a relatively difficult and time-consuming procedure. Dissection of the STA, on the other hand, is much easier. Preoperative measurements of local cerebral blood flow in the vertebrobasilar circulation before and after intravenous administration of acetazolamide (500 mg) were obtained, and demonstrated low flow and hemodynamic compromise in the posterior circulation. The patient's hemodynamic and neurological status improved following surgery. In this report, we present a new and simplified method of OA-AICA anastomosis with interposition of STA graft.

Anastomosis, Surgical↗
PubMed1993

Long-term follow-up study of "epileptic type" moyamoya disease in children.

Twenty-three patients with epileptic type moyamoya disease are reviewed among 200 moyamoya disease patients. Ten boys and 13 girls aged 5 months to 12 years were followed over 6 months to 17.3 years. Six had generalized seizure and 17 had focal seizure. Operations were performed within 1 year in eight patients, within 1-3 years in five, and more than 3 years after onset in 10. Nineteen patients improved and suffered no seizure without receiving antiepileptic drugs, but four patients developed true epilepsy and three of these suffered cerebral infarction. Multivariate analyses showed that toddlers aged less than 1 year and mild or severe abnormal computed tomographic (CT) findings correlated with a bad outcome. This study showed that epileptic type moyamoya disease has the same clinical features as transient ischemic attack or infarction type. Age under 1 year and CT abnormalities indicate a poor prognosis and necessity for early reconstructive surgery.

Child↗
PubMed1993

[Spike discharge detected by intra-arterial electroencephalography from intra-arterial guide wire in temporal lobe epilepsy].

The implantation of electrodes for intracranial electroencephalography (EEG) recording as presurgical evaluation of patients with intractable epilepsy is at present most important for planning epilepsy surgery. This method is most effective in temporal lobe epilepsy. We carried out intracranial EEG by means of insulated micro guide wire for endovascular surgery in two temporal lobe epilepsy cases, and spike discharges could be detected in lesional medial temporal lobe. Case 1 is a 29 year-old-male suffered from intractable complex partial seizure (CPS) for 18 years. He was diagnosed as left temporal lobe epilepsy and performed removal of amygdala, hippocampus, parahippocampal gyrus and fusiform gyrus. Case 2 is a 16 year-old-lady suffered from drug resistant CPS for 4 years. Under the diagnosis of right temporal lobe epilepsy, temporal lobectomy was performed. As the presurgical evaluation, under the implantation of subdural strip electrode in both cases, we carried intra-arterial EEG after angiography. Seeker Lite-10 guide wire was insulated with Tracker-10 unibody infusion catheter at sphenoidal portion of middle cerebral artery, and frequent interictal spike discharge was detected in lesional medial temporal lobes by two methods simultaneously.

Adolescent↗
PubMed1993

[Multiple subpial transection after lesionectomy in an intractable epilepsy case].

A Sixty-one-year-old man was admitted to our hospital because of generalized convulsion. He had suffered from intractable epilepsy for 26 years. CT and MRI showed the right frontal cavernous angioma. On operation, intraoperative electrocorticography was performed after lesionectomy including surrounding glial scar and hemosiderin laden tissue. It showed epileptiform potentials in neighbor gyrus of the lesion. Because the removed sphere would be so broad, and we performed multiple subpial transection (MST). After MST, depression of background electrical activity and disappearance of spike discharge are seen. One and half year after operation, seizure was controlled by only phenobarbital administration.

Brain Neoplasms↗
PubMed1993

[Leigh's syndrome and mitochondrial myopathy].

Leigh's syndrome is a subacute encephalopathy with characteristic pathological features and lactic acidosis. This syndrome is due to the disturbance of aerobic metabolism. Pyruvate dehydrogenase deficiency and cytochrome c oxidase deficiency are common metabolic disturbances in this syndrome. Complex I or II deficiency has also been claimed. Recently, mutations of mitochondrial genome have been also identified in some cases with Leigh's syndrome: np 3243 T to C, np 8344 G to A and np 8993 T to G. The possible correlation between phenotype and genotype in this heterogeneous syndrome was discussed.

Cytochrome-c Oxidase Deficiency↗
PubMed1993

[Surgical excision of a cavernous angioma of the cerebral peduncle by orbito-fronto-malar approach].

A case with cavernous angioma at the left cerebral peduncle was cured surgically. A 36-year-old male was admitted with complaints of right facial palsy, right motor disturbance and cheiro-oral syndrome. CT revealed a round high-density mass in the left cerebral peduncle and thalamus. Angiography showed no abnormality. MRI showed a round high-intensity mass on T1-and T2-weighted image in the left thalamus, which meant hematoma at a subacute stage and mixed-intensity core in the left cerebral peduncle, which was cavernous angioma. Symptoms disappeared, and high-density also disappeared gradually, but rebleeding occurred. Because of this, an operation was performed by the orbitofrontmalar approach. Hematoma and angioma were removed under ABR and SEP monitor, which showed no abnormality during the operation. Histological examination of the surgical specimen revealed that the abnormal vessels were cavernous angioma. The postoperative course was uneventful without cosmetic problems.

Adult↗
PubMed1993

[Surgical excision of a huge olfactory groove meningioma by extensive transfrontal approach].

A case with a huge olfactory groove meningioma was cured surgically by extensive transfrontal approach. A 46-year-old female was admitted with complains of left visual disturbance. CT revealed a large high-density mass in the base of the frontal fossa which was enhanced homogenously. Hyperostosis was seen in the planum sphenoidale. MRI showed a relatively low intensity with a peritumoral low-intensity rim on T1WI and high intensity on T2WI. The brain stem had shifted dorsally. Rich feeding to the lesion from the ethmoidal artery was seen on angiography. An operation was performed using an extensive transfrontal approach. After bifrontal craniotomy, orbitofrontal osteotomy was performed. This approach enabled us to minimize frontal lobe retraction, to interrupt the blood supply to the tumor early, and to remove the tumor completely from the frontal base and to present invasion of the sinuses. The postoperative course was uneventful without cosmetic problems.

Brain Neoplasms↗
PubMed1992

Neuroepithelial cyst of the lateral ventricle. Clinical features and treatment.

This report concerns eight patients with noncolloid neuroepithelial cyst of the lateral ventricle, including four surgical and four conservative cases. Of the surgical patients, two had headache, one had orbital pain, and one had seizures. In the conservative group there were no symptoms due to the cysts and no changes in computed tomography scan during follow-up for an average of 1.4 years. Magnetic resonance imaging was performed in five cases and showed a cyst with an intensity similar to cerebrospinal fluid, while a cyst membrane was also detected in three cases. Our findings suggest that (1) the majority of symptomatic neuroepithelial cysts in the lateral ventricle are located in the trigone; (2) the cause of symptoms suggestive of obstruction, such as headache, is an isolated ventricle that demonstrates dilatation of the inferior horn on computed tomography and magnetic resonance imaging; (3) the operative indication is obstructive symptoms; and (4) cyst-peritoneal shunt is an effective procedure.

Adult↗