Biomedical subjects
Publications and source records attributed to J Handa.
The authors report the case of an adult male who had multiple sinus pericranii, as well as angiomas in the retina and the skin of the knee. Although sinus pericranii is well documented, a simultaneous involvement in as many as four separate regions has not been reported. Clinical, radiographic, and histopathological features are detailed. Implications for the role of surgery and management is discussed.
Two cases of spontaneous dissecting aneurysm localized to the anterior cerebral artery are reported. Both patients experienced severe headaches, followed by symptoms of cerebral ischemia. In the first case, the dissecting aneurysm showed an angiographic appearance resembling a saccular aneurysm of the anterior communicating artery, and the diagnosis of dissecting aneurysm was confirmed at operation. The second case was treated conservatively, and the diagnosis was reached by repeat angiographic studies.
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Hypoxic effects on glutamate uptake and ATP content in glial cells were investigated by using cultured C6 glioma cells. Mild regressive changes were found depending on the duration of the hypoxic insult, but necrosis or detachment of the cells from the substratum was rarely observed. Glutamate uptake was relatively well preserved after a short hypoxic insult, while a marked decrease in glutamate uptake was observed after hypoxia of long duration. The uptake of sucrose was reduced in a similar pattern to glutamate uptake. Hypoxic insult resulted in a significant reduction of the ATP content in glial cells. Therefore, the decrease in glutamate uptake by glial cells under hypoxia is likely to be due to ATP dependency, and not to the failure of a specific glutamate uptake system, but the failure of a general uptake of the glial cells owing to the energy-dependent membrane dysfunction by ATP depletion. These findings suggest that there are phased changes of astrocytic functions in a hypoxic condition, a preservative phase in the initial stages and then a dysfunctional phase in the later stages of hypoxia.
Dermoid cysts in the central nervous system are often associated with various congenital disorders, especially dermal sinus and spina bifida. We report a case of dermoid cyst in the fourth ventricle associated with Klippel-Feil syndrome. A 47-year-old man with a long history of headache had been known to have a cystic lesion in the posterior fossa for 12 years. When he was referred to our hospital with complaints of transient tetraparesis, he showed bilateral cerebellar ataxia and minimal left hemiparesis. Furthermore, he was noted to have a webbed neck with a low hairline and facial asymmetry. CT and MRI showed multiple cerebral infarctions as well as a mass lesion in the posterior fossa. Cervical roentgenogram showed a fusion of C 2 and C 3 vertebrae. The tumor was totally removed via a suboccipital approach, and the diagnosis was a dermoid cyst. The present patient had not only dermoid cyst and Klippel-Feil syndrome but also hypertrophy of the zygomatic bone. The pathogenesis of the Klippel-Feil syndrome is presumed to be an intrauterine defect, with a failure of segmentation of mesodermal somites. The zygomatic bone is also derived from the mesoderm somites at early fourth week, too. From these points of view, the disturbance in the mesoderm before the fourth week of gestation might have played an important role in causing a dermoid cyst.
Ossification of ligamentum flavum was reported usually lower thoracic and lumbar region, and rarely seen in the cervical region. Calcification of cervical ligamentum flavum is also relatively rare. We report a case of ossification and another of calcification of cervical ligamentum flavum, and discussed the difference of the clinical and radiological features in these conditions. Case 1: A 55-year-old man presented with numbness of the left shoulder and urinary dysfunction. Neurological examination revealed weakness, muscle atrophy and elevated deep tendon reflexes of the left extremities. CT showed ossified mass protruding into the right side of the canal and compressing the spinal cord at C 3/4 and C 4/5. MRI showed low intensity mass both on T1- and T2-weighted images and severe compression of the spinal cord. Left side partial hemilaminectomy with foraminotomy, so called "key hole" foraminotomy, satisfactorily decompressed the cord with clinical improvement. Case 2: A 70-year-old woman complained numbness of both hands for two years. She had sensory disturbance of both hands and spastic gait disturbance. Cervical X-ray films showed calcified nodules on the inner surface of lamina at C4/5. Axial CT demonstrated calcification in the ligamentum flavum at the C4/5 and C5/6 levels. MRI showed posterior spinal cord compression at the C4/5 and C5/6 levels. Osteoplastic laminotomy and removal of the affected ligamentum flavum were performed with successful result. Only 8 cases ossification of cervical ligamentum flavum above C6/7 have been so far reported. All are Japanese; four male and four female cases.(ABSTRACT TRUNCATED AT 250 WORDS)
The binding affinities of seven lectins to four epidermoid and three dermoid cysts were studied and the results were compared with the epidermis and the oral mucosa. The reactivity of four epidermoid cysts of the fourth ventricle and the frontal lobe, and one dermoid cyst in the sylvian fissure was consistent with that of the skin, whereas the binding profile of one parasellar dermoid cyst was identical to that of the keratinized oral mucosa. Another parasellar dermoid cyst also showed close similarity to the buccal mucosa. These results indicate that cells of these cysts develop same glycoconjugates as do normal epithelial cells, and some of these cysts around the sellar region might be derived from the cells of the oral mucosa.
A rare case of lingual carcinoma which metastasized to the brain is reported. A 66-year-old man was referred to our department on April 23, 1991, with complaints of memory disturbance and mild left motor weakness of one month's duration. The patient had been discharged from the Department of Otolaryngology of our hospital 9 months before, after undergoing radical neck dissection and chemotherapy (THP, CDDP, PEP) for his lingual cancer with metastases to the cervical lymph nodes and the lung. On admission to our department, the patient complained of mild frontalgia. Neurological examination showed memory disturbance, change of character, mild left hemiparesis and urinary incontinence. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a well circumscribed mass in the right frontal lobe associated with midline shift toward the left. Systemic Gallium-67 scintigraphy demonstrated an abnormal uptake in the right frontal region, but no abnormal uptake was seen in the neck and the lung. The most likely diagnosis was thought to be metastasis of lingual cancer. The patient underwent tumor removal 10 days after admission. A histological examination of the tumor specimen revealed metastatic anaplastic cell carcinoma, indicating a metastasis from lingual carcinoma. After postoperative radiotherapy (total 60 Gy), the patient was discharged without neurological deficit. Central nervous system metastasis from lingual carcinoma is quite rare. To the best of our knowledge, only two such cases have been reported. We report another rare case of solitary brain metastasis from lingual carcinoma and review the pertinent medical literature.
We report a case of Creutzfeldt-Jakob disease in a 38-year-old man, transmitted by a cadaveric dural graft. In August 1985, he underwent cranial nerve decompression for hemifacial spasm and received a cadaveric dural graft for dural closure. He had been well until he began to complain of blurred vision and headache in May, 1990. He developed dementia, myoclonus and urinary incontinence over the subsequent 3 months. He was admitted to our hospital in August, 1990. On admission, he was somnolent and showed gait disturbance, myoclonus in extremities and elevated deep tendon reflexes symmetrically. The results of analysis of blood, urinary and cerebrospinal fluid were normal. The initial computed tomography (CT) and magnetic resonance imaging detected no abnormality. Electroencephalography showed typical periodic synchronous discharge (PSD). There was progressive worsening of his neurological symptoms, and this developed into mutism in September, 1990. CT, 11 months after clinical onset, showed marked enlargement of the ventricles and the sulci. In view of his rapid worsening clinical course, PSD findings on electroencephalography, and delayed progressive changes of CT findings, the diagnosis of CJD disease was made. The cadaveric dural graft was suspected as the cause of the patient's condition. Since Thadani et al reported the first case of CJD transmitted by cadaveric dural graft in 1988, 3 other cases have been reported. This is most likely the 5th reported case of Creutzfeldt-Jakob disease transmitted by cadaveric dural graft.
A patient with an enhancing, completely intracanalicular mass on MRI was presented. He had noticed progressive hearing loss in the left ear with tinnitus. Neurological examination revealed no abnormality except decreased hearing in the left ear. There were no other cranial nerve or cerebellar signs. An audiogram revealed profound hearing loss on the left ear with no ability of speech discrimination. Brainstem auditory evoked response was absent on the left. MRI enhanced with gadolinium-DTPA demonstrated an intracanalicular enhancing lesion on the left which was presumed to be an intracanalicular acoustic neurinoma. The patient underwent a left suboccipital craniectomy. The eighth cranial nerve appeared normal in the cerebellopontine angle cistern, and was swollen and discolored in the internal auditory canal. It was removed piecemeal. The patient remained deaf in the left ear postoperatively. Histopathologically, the lesion consisted of edematous nerve fiber and inflammatory cells, but no tumor cell was present within the specimen. The patient was diagnosed as having neuritis. The clinical time course of symptoms in our patient was not unusual for an acoustic neurinoma. It seems that the distinction between an intracanalicular acoustic neurinoma and other lesions cannot be made on basis of MR imaging alone. All available imaging modalities should be considered before a definitive surgical procedure is undertaken.
Brain transplantation has been examined as one of the therapeutic methods in the animal models of Alzheimer's disease. Among a lot of problems inherent to therapeutic brain transplantation, we have investigated implanting techniques and methods. Small pieces of fetal basal forebrain tissue containing cholinergic neurons were transplanted into adult rats' cerebral cortex, lateral ventricle, subarachnoid space, and the cerebral cortical cavity which had been made 10 days before transplantation (delayed cavity technique). Two to 3 months after transplantation, growth of the grafts, neurites elongation and astrocytic reaction were observed by Nissl staining, histochemical staining for acetylcholinesterase and immunocytochemical staining for glial fibrillary acidic protein (GFAP). Intracortical grafts were small and surrounded by thick glial scar formation, but there was found a partial lack of glial scar and host-graft neuronal integration was also observed. Both intraventricular and subarachnoid grafts grew relatively well. GFAP-immunoreactive cells had a tendency to gather near the margin of the graft and perivascularly. These facts seemed to suggest that reactive astrocytes were also taking part in support of the homeostasis of environments in the graft tissue. By delayed cavity technique, better growth of the grafts was observed, but dense glial and connective tissue scar tissues developed and prevented the outgrowth of neuronal processes. Nevertheless, hyperinnervation from graft to host cortex was partially noticed. It should be stressed that although the hyperinnervation may be effective for recovery of the host from the central nervous system damages, it may possibly damage the host's neuronal circuits.
Suspensions of basal forebrain cells of fetal rats were transplanted into the subarachnoid space of adult rats through a microsyringe needle which was transcortically inserted to the subarachnoid space. Two to 3 months after the transplantation, growth of the graft, neuritic elongation, neovascularization, and astrocytic reaction were examined by Nissl staining, histochemical staining for acethylcholinesterase and Klüver-Barrera's myelin staining, vascular relief images and immunohistochemical staining for laminin, and immunocytochemical staining for glial fibrillary acidic protein (GFAP). Transplanted fetal neurons survived and grew very well over the brain surface and exhibited facilitated neuritic elongation. Several bundles of myelinated fibers linking the subarachnoid and the subpial grafted cells were noticed, but the myelinated fibers penetrating the intact pia mater were not verified. In the grafted tissue, extracellular matrix was formed and a lot of small vessels and capillaries were noticed. Many GFAP-immunoreactive cells were seen in the graft. They had a tendency to gather perivascularly and near the margin of the graft tissue facing subarachnoid space. The subarachnoid space is thought to be an adequate place for transplanted neuronal and glial cells to grow. The subarachnoid space contains the cerebrospinal fluid and also it contacts with rich pial vessels, so that it seems to be superior to the intraparenchymal area in respects of a supply of oxygen and nutrition and of low tissue pressure. Transplanted tissue may be supposed to work as the exocrine and/or endocrine organ which secretes neurotransmitters and their synthetic enzymes and neurotrophic factors. If this is true, it would imply that the subarachnoid space is considered as a promising site for implantation.
The effects of progressive ventricular dilation on the development of the somatosensory cortex (SmI) were studied in congenital hydrocephalic rats, with regard to early serotonergic innervation and formation of functional cellular columns. In hydrocephalic rats, the time course, immunoreactivity, and patterns of formation and synaptogenesis of serotonin immunoreactive (5-HT-IR) terminal aggregations, which characterize the development of the SmI, were preserved. After disappearance of 5-HT-IR terminals, characteristic barrel cytoarchitecture formed normally at the site where 5-HT-IR terminal aggregations had been present. With the progression of hydrocephalus, the cerebral cortex became extremely thin and its total surface area was greatly increased, while barrels were preserved and their areas did not enlarge. These findings suggest that the basic development and the fundamental cytoarchitecture of the cortex are resistant to adverse effects of hydrocephalus.
To clarify the participation of endothelial-cell-derived growth factors (ECDGFs) in astrocytosis, the effects of endothelial-cell-conditioned medium (ECCM) derived either from normotensive rats or spontaneously hypertensive, stroke-prone rats (SHRSPs) on proliferation of C6 cells of an established rat glioma cell line were bioassayed. The ECCM from both strains stimulated proliferation of astrocytes, but the ECCM from SHRSPs showed a higher mitogenic activity for astrocytes than that from normotensive rats. Growth-promoting activity of the ECCM derived from SHRSPs showed an increase that was linear to the conditioning time. These results seem to indicate that endothelial cells produce and release factors that promote the growth of astrocytes. It seems also probable that chronic hypertension causes an increase in production and release of such ECDGFs that correlated with astrocytic proliferation.
Two cases of subependymoma in the cervical spinal cord associated with stigmata of neurofibromatosis are reported. Magnetic resonance (MR) imaging showed one tumor with a sharp margin, which was well-demarcated intraoperatively and was totally removed. MR imaging showed the other tumor with an irregular margin, which was partly invasive at operation. Subependymomas are rare in the spinal cord and these are the first reported associations with neurofibromatosis.
Twelve cases of primary malignant lymphoma of the central nervous system had been treated since April, 1979 to August, 1990. Radiation therapy was completed in ten of them without adjuvant chemotherapy, and the other two patients expired before or during radiation therapy. In spite of good response to the radiation therapy, five of the ten patients died within 2 years. Three cases are alive after more than 5 years, and there has been no recurrence. In eight cases, the number of the argyrophilic proteins of the nucleolar organizer regions (AgNORs) was counted in the formalin-fixed paraffin embedded sections. In those cases with an AgNOR number of 4.0 or higher, prognosis was significantly worse than in the others. AgNOR number may be used as one of the reliable factors in the prognosis of primary malignant lymphoma of the central nervous system.
A case of agenesis of the internal carotid artery combined with arachnoid cyst is reported. This 11-year-old boy had occasionally complained headache and nausea since he was of 9 years old. He was admitted to our hospital because of an epileptic seizure. Physical and neurological examinations on admission were normal. A CT scan showed a cystic mass in retrocerebellar region. MRI suggested absence of flow void area indicating internal carotid artery in the cavernous sinus on left side. Left common carotid angiogram showed absence of the internal carotid artery. Bilateral A2 segments were supplied by right A1 with tortuous anterior communicating artery. Left middle cerebral artery and left ophthalmic artery were supplied via dilated left posterior communicating artery on left vertebral angiogram. Thin slice, axial target image of the CT revealed absence of the left bony carotid canal. MRI by 3D TOF method confirmed no blood flow in this area. MR angiography provided sufficient information about cervical vessels non-invasively. 123I-IMP SPECT image ascertained no hypoperfusion area in left cerebral hemisphere. Convulsion was controlled with sodium valproate. Association of agenesis of the internal carotid artery and arachnoid cyst could be a coincidence.
A patient with a diploic meningioma is presented. Computed tomography (CT) scan revealed an intradiploic tumor which seemed contiguous at a point to a contralateral, recurrent parasagittal meningioma. On CT, density of the diploic meningioma was similar to that of the parasagittal meningioma, but the contrast study showed that the former enhanced much less than the latter. Magnetic resonance (MR) imaging demonstrated that the diploic tumor was heterogeneous and much less enhanced with Gadolinium-DTPA (Gd-DTPA) than the parasagittal meningioma on T1-weighted image, although they were very similar in signal intensities on T2-weighted and proton density-weighted MR images without Gd-DTPA. Reasons for such marked differences in enhancement patterns are discussed.