[Successful aortic valve replacement in a patient with esophageal varix].
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Biomedical subjects
Publications and source records attributed to H Nogaki.
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CT scans were obtained on 33 patients (age 73y. to 31y.) with the diagnosis of normal pressure hydrocephalus. In each case, the diagnosis was made on the basis of the symptoms, CT and cisternographic findings. Underlying diseases of normal pressure hydrocephalus are ruptured aneurysms (21 cases), arteriovenous malformations (2 cases), head trauma (1 case), cerebrovascular accidents (1 case) and idiopathy (8 cases). Sixteen of 33 patients showed marked improvement, five, moderate or minimal improvement, and twelve, no change. The results were compared with CT findings and clinical response to shunting. CT findings were classified into five types, bases on the degree of periventricular hypodensity (P.V.H.), the extent of brain damage by underlying diseases, and the degree of cortical atrophy. In 17 cases of type (I), CT shows the presence of P.V.H. with or without minimal frontal lobe damage and no cortical atrophy. The good surgical improvements were achieved in all cases of type (I) by shunting. In 4 cases of type (II), CT shows the presence of P.V.H. and severe brain damage without cortical atrophy. The fair clinical improvements were achieved in 2 cases (50%) by shunting. In one case of type (III), CT shows the absence of P.V.H. without brain damage nor cortical atrophy. No clinical improvement was obtained by shunting in this type. In 9 cases of type (IV) with mild cortical atrophy, the fair clinical improvement was achieved in two cases (22%) and no improvement in 7 cases. In 2 cases of type (V) with moderate or marked cortical atrophy, no clinical improvement was obtained by shunting. In conclusion, it appeared from the present study that there was a good correlation between the result of shunting and the type of CT, and clinical response to shunting operation might be predicted by classification of CT findings.
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Operative mortality and morbidity for intracerebral aneurysms has recently reduced with microsurgical technique, so more functional prognosis such as visual disturbance due to fundal hemorrhages has been studied. Here vitreous hemorrhage secondary to ruptured cerebral aneurysms (Terson syndrome) was attentioned. Three patients had more over 2 hours of unconsciousness and one patient experienced repeated episodes of subarachnoid hemorrhage within a week. This suggested rapid increased intracranial pressure resulted in vitreous hemorrhage through the venous congestion, which had been reported by Castrén (1963). All patients became blind because of severe vitreous hemorrhage. First case was followed over 7 years with only conservative therapy, but failed to improve. Another 3 cases regained visual acuity soon after operation. We emphasized vitreous hemorrhage as an important functional prognostic factor after ruptured intracerebral aneurysms and effective results of vitrectomy was showed.
Cerebrospinal fluid flow dynamics of 15 patients with occlusive cerebrovascular diseases was studied using RI cisternography (RIC) and Metrizamide CT cisternography (CTC) and these methods were compared. RIC demonstrated RI retention in 9 patients, which was noticed in all chronic stage patients (over one month after apopletic episode). Five patients had subarachnoid block in affected cerebral hemisphere. Ventricular reflux, however, was present in only one patient. Metrizamide CTC (170 mgI/ml) showed ventricular reflux or stasis in 11 of 16 patients. Seven patients revaaled asymmetrical metrizamide filling of Sylvian fissures at 3 or 6 hours after intrathecal injection of Metrizamide. Asymmetrical demonstration of Sylvian fissure after 3 hours in 3 patients corresponded with the finding of subarachnoid block at the same side on RIC. The clinical values of CTC were emphasized on the basis of this investigation. Ventricular reflux or stasis, which indicated one of the important findings on cerebrospinal fluid flow disturbance, was easily and clearly detected. Asymmetrical metrizamide filling of Sylvian fissures at 3 hours after injection was compatible with subarachnoid block on RIC.
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