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Biomedical subjects

K Houkin

Publications and source records attributed to K Houkin.

At least 73 records · Page 4Linked to original sources
PubMed1997

Development of anterior cranial fossa dural arteriovenous malformation following head trauma. Case report.

Dural arteriovenous malformations (AVMs) are considered to be acquired lesions that develop secondary to venous obstruction, which sometimes happens in head trauma. However, there has been a report of an anterior cranial fossa dural AVM that occurred independently of a history of head trauma, and there has been speculation that these malformations are congenital. The authors recount their experience with a patient who had an anterior cranial fossa dural AVM that was discovered incidentally. The lesion was fed by the bilateral anterior ethmoidal arteries and drained into the superior sagittal sinus via frontal cortical veins. The patient had a history of severe head trauma that had occurred 30 years earlier. This is the first case report in which a previous head trauma is strongly believed to be the cause of an anterior cranial fossa dural AVM. The authors postulate that anterior cranial fossa dural AVMs can develop secondary to a head trauma.

Aged↗
PubMed1997

Cerebral abscess as an unusual complication of coil embolization in a dural arteriovenous fistula. Case report.

This 63-year-old man presented with a right temporoparietal cortical infarction. A dural arteriovenous fistula involving the right transverse sinus was diagnosed on cerebral angiography. Transvenous embolization using detachable coils was performed; however, postembolization angiograms demonstrated retrograde filling of a cortical draining vein that was not seen on initial angiography. The patient subsequently developed a cerebral abscess in the region of the previous cortical infarction 2 months after the embolization. The abscess was successfully treated with drainage and antibiotic therapy. The authors report this case to illustrate an unusual complication associated with this procedure and the possible contribution of the cortical draining vein in the pathogenesis of the cerebral abscess.

Angiography, Digital Subtraction↗
PubMed1997

[IC-IC bypass].

Explore the source record for details and available documents.

Basilar Artery↗
PubMed1996

Cerebral hypoxia after hyperventilation causes "re-build-up" phenomenon and TIA in childhood moyamoya disease. A near-infrared spectroscopy study.

Near-infrared spectroscopy was used to monitor the sequential changes in the cerebral oxygenation state during and after hyperventilation in two children with moyamoya disease. Hyperventilation induced the build-up phenomenon and a decrease in the concentration of oxy-hemoglobin ([oxy-Hb]) and total hemoglobin ([t-Hb]). The termination of hyperventilation was followed by partial recovery of [oxy-Hb] and [t-Hb]. Subsequently, however, [oxy-Hb] and [t-Hb] decreased again and cytochrome oxidase was reduced. These impairments of the cerebral hemodynamics and oxygen metabolism were closely associated with the re-build-up phenomenon on EEG and with transient ischemic attacks (TIA). The present study implies that cerebral hypoxia after hyperventilation is closely related to the re-build-up phenomenon and ischemic attacks in children with moyamoya disease.

Anastomosis, Surgical↗
PubMed1996

Regional cerebral hemodynamics during re-build-up phenomenon in childhood moyamoya disease. An analysis using 99mTc-HMPAO SPECT.

We investigated the role of ischemic hypoxia in the appearance of re-build-up phenomenon on electroencephalography in childhood moyamoya disease using 99mTc-hexamethyl propyleneamine oxime and single photon emission computed tomography (99mTc-HMPAO SPECT). In the case reported on, critical reduction of regional cerebral blood flow (rCBF) was observed during re-build-up phenomenon in the bilateral parieto-occipital area where acetazolamide testing revealed severe impairment of the perfusion reserve. On electroencephalography, the re-build-up phenomenon originated in these areas. In addition, re-build-up phenomenon developed into the entire hemisphere 30 s later, even where the severe ischemia was not observed. These results suggest that rCBF reduction induced by hyperventilation plays a critical role in the appearance of the re-build-up phenomenon, but other factors such as ischemic hypoxia after hyperventilation are also important in the development of this phenomenon.

Brain↗
PubMed1996

Moyamoya disease with precocious puberty and pustular psoriasis.

An 8-year-old girl suffering from precocious puberty and pustular psoriasis with moyamoya disease is described. The possibilities of a causal relationship between precocious puberty and moyamoya disease are discussed. The relevance of the patient's earlier upper respiratory tract infections to the pustular psoriasis and moyamoya disease is also considered.

Child↗
PubMed1996

Near-infrared monitoring of cerebral oxygenation state during carotid endarterectomy.

BACKGROUND: Recent studies have indicated that near-infrared spectroscopy (NIRS) could continuously and noninvasively observe the changes in cerebral oxygenation state during hypoxia and ischemia, using their optical properties. Its validity and usefulness during cerebrovascular surgery, however, still remain to be clarified. METHODS: Using NIRS, we continuously monitored the changes in the concentration of oxyhemoglobin, deoxyhemoglobin, and total hemoglobin ([oxy-HB], [deoxy-Hb], and [total Hb], respectively) and redox state of cytochrome oxidase (cyt ox) during carotid endarterectomy for 22 patients, and we compared the NIRS responses with those of intraoperative somatosensory evoked potentials (SEP) and regional cerebral blood flow (rCBF). RESULTS: In 9 of 22 patients, cross-clamping of the carotid artery caused a continuous decrease [oxy-Hb] and [total Hb], and an increase in [deoxy-Hb]. Cyt ox was partially reduced during the clamping. These NIRS responses demonstrated the occurrence of severe hypoxia in the ipsilateral cerebral tissue. These patients showed a marked decrease in the N20 amplitude of SEP and rCBF. In contrast, the other 13 patients did not show a significant decrease in the cerebral oxygenation state, which showed no remarkable changes in either SEP or in rCBF. CONCLUSIONS: NIRS could successfully jude the cerebral oxygenation state noninvasively during carotid surgery and was more sensitive to ischemic crisis than other indirect methods.

Aged↗
PubMed1996

Dissociation of vasoreactivity to acetazolamide and hypercapnia. Comparative study in patients with chronic occlusive major cerebral artery disease.

BACKGROUND AND PURPOSE: The aim of this study was to compare the effect of vasodilative stimuli for the measurement of cerebrovascular reactivity obtained by acetazolamide and hypercapnia in patients with chronic occlusive major cerebral artery disease. METHODS: We examined 24 patients with unilateral occlusive lesions of a major cerebral artery using the 133Xe inhalation technique and single-photon emission CT. Regional cerebral blood flow (CBF) was measured during a resting state, during inhalation of 5% CO2, and 15 minutes after the administration of acetazolamide consecutively in the same patients. Normative values of resting CBF and acetazolamide reactivity were obtained in 21 normal subjects. RESULTS: All patients with the exception of 1 showed an increase in CBF during hypercapnia ipsilateral to the occlusive lesion. Ipsilateral acetazolamide reactivity was preserved in 13 patients. Conversely, 11 patients showed an absent response or paradoxical CBF reduction. Ipsilateral CO2 reactivity did not correlate with acetazolamide reactivity when all 24 patients were considered. However, there was a significant correlation between acetazolamide and CO2 in the 13 patients who showed preserved acetazolamide reactivity (r = .60, P < .05). No significant correlation was present in the remaining 11 patients with reduced acetazolamide reactivity. Although significant blood pressure augmentation was observed in hypercapnia, we could not find a correlation between change of blood pressure and CO2 reactivity. CONCLUSIONS: Acetazolamide identified patients with reduced vasomotor reactivity who appeared to have preserved CO2 reactivity. Acetazolamide testing may be useful in the assessment of cerebral hemodynamics. However, further investigations are necessary to assess the clinical utility of these tests.

Acetazolamide↗
PubMed1996

Angiogenic factors in moyamoya disease.

BACKGROUND AND PURPOSE: We previously reported that the level of basic fibroblast growth factor (bFGF) is high in cerebrospinal fluid (CSF) taken from patients with moyamoya disease. The present study investigated the levels of other angiogenic growth factors in the CSF of moyamoya patients and the clinical significance of bFGF in moyamoya disease. METHODS: The levels of bFGF, interleukin-8, platelet-derived growth factor, transforming growth factor-beta, endothelial growth factor, and vascular endothelial cell growth factor in CSF, taken from 38 patients with moyamoya disease and 16 patients with atherosclerotic occlusive disease (control group), were measured by an enzyme-linked immunosorbent assay. We analyzed the correlation between the level of bFGF and the clinical factors of age, onset pattern, development of neovascularization, and cerebral circulation. RESULTS: The CSF of moyamoya patients contained a high concentration of bFGF to a significant (P < .05) extent. The bFGF level was apparently elevated in the patients in whom neovascularization from indirect revascularization, such as encephaloduroarteriosynangiosis, was well developed (P < .01). A linear correlation between the values of bFGF and cerebral vascular response to acetazolamide (r = .7; P < .05) was revealed. The other angiogenic factors were not significantly high compared with the control group. CONCLUSIONS: The elevation of bFGF in moyamoya disease seems to be specific and is not related simply to cerebral ischemia. Clinically, the bFGF level is a useful indicator to predict the efficacy of indirect revascularization after surgery.

Adult↗
PubMed1996

Surgical therapy for adult moyamoya disease. Can surgical revascularization prevent the recurrence of intracerebral hemorrhage?

BACKGROUND AND PURPOSE: It is well recognized that revascularization surgery using direct and/or indirect bypass provides effective surgical management for pediatric moyamoya disease. However, surgical treatment of the adult hemorrhagic type remains controversial. In this study, the effect of surgery for adult moyamoya disease was investigated. METHODS: We analyzed 35 patients with adult moyamoya disease (patient age, over 20 years), 24 patients with initial onset of intracerebral hemorrhage, and 11 patients with initial onset of cerebral ischemia who underwent both direct bypass surgery of the superficial temporal artery to the middle cerebral artery anastomosis and indirect revascularization of encephalo-duro-arteriomyo-synangiosis. RESULTS: Of 24 patients with hemorrhagic-type disease, 3 showed rebleeding: of 11 patients with the ischemic type, 2 showed intracerebral hemorrhage after surgery. Overall, 5 of 35 patients (14.3%) had hemorrhage after revascularization surgery (mean follow-up period, 6.4 years). Postoperative angiography revealed that direct anastomosis is effective whereas indirect revascularization is not always effective for adult moyamoya disease. Moyamoya vessels, which are supposed to be responsible for hemorrhage, decreased in 25% of patients. CONCLUSIONS: Revascularization surgery cannot always prevent rebleeding. However, a decrease in moyamoya vessels was induced by surgery, which may reduce the risk of hemorrhage more effectively than conservative treatment. In cases of adult moyamoya disease, direct bypass is particularly important, since the indirect revascularization is not as useful in adult cases as in pediatric cases.

Adult↗
PubMed1996

Intracellular adhesion molecule-1 and lymphocyte function-associated antigen-1 expression in a rat forebrain reperfusion model.

Activated leukocytes may be involved in the reperfusion injury of the brain. The expression of intracellular adhesion molecule-1 (ICAM-1) (CD54) and lymphocyte function-associated antigen-1 (LFA-1) (CD11a/CD18) are important for the interaction of activated leukocytes with the brain. Therefore, the expression of ICAM-1 in the cerebral vessels and LFA-1 on leukocytes were examined after reperfusion in a rat four-vessel occlusion model. Model rats underwent reperfusion (15, 30, and 60 min, and 6, 12, and 24 hrs) following 30 minutes of forebrain ischemia. Immunohistological staining for ICAM-1 and LFA-1 was performed in each subgroup. ICAM-1 expression increased after 1-hour reperfusion and persisted on the cerebral microvessels in both the subcortical region and the basal ganglia. Leukocytes stained by LFA-1 were observed in the capillary vessels after 6-hour reperfusion. Increased expression of ICAM-1 and LFA-1 were induced by reperfusion, and this may be important in reperfusion injury of the brain.

Animals↗
PubMed1996

Magnetic resonance imaging of cold injury-induced brain edema in rats.

The chronological changes of blood-brain barrier disruption, and diffusion and absorption of edema fluid were investigated in rats with cold-induced brain injury (vasogenic edema) using magnetic resonance imaging. Contrast medium was administered intravenously at 3 and 24 hours after lesioning as a tracer of edema fluid. Serial T1-weighted multiple-slice images were obtained for 180 minutes after contrast administration. Disruption of the blood-brain barrier was more prominent at 24 hours after lesioning than at 3 hours. Contrast medium leaked from the periphery of the injury and gradually diffused to the center of the lesion. Contrast medium diffused into the corpus callosum and the ventricular system (cerebrospinal fluid). Disruption of the blood-brain barrier induced by cold injury was most prominent at the periphery of the vasogenic edema. Edema fluid subsequently extended into the center of the lesion and was also absorbed by the ventricular system. Magnetic resonance imaging is a useful method to assess the efficacy of therapy for vasogenic edema.

Animals↗
PubMed1996

Cerebral hemodynamic changes during carotid artery balloon occlusion monitored by near-infrared spectroscopy.

The cerebral oxygenation state of five patients was continuously and non-invasively monitored using near-infrared spectroscopy (NIRS) during carotid artery balloon occlusion for comparison with somatosensory evoked potential (SEP) monitoring and regional cerebral blood flow (rCBF) measurements. In patients with marked reduction of rCBF and deteriorated SEP, NIRS demonstrated a continuous decrease in oxy-hemoglobin and total hemoglobin and an increase in deoxy-hemoglobin, indicating the occurrence of severe hypoxia in the ipsilateral hemisphere because of inadequate collateral circulation. In contrast, NIRS showed only a transient (<2 min) change in these parameters in the patients who showed no remarkable changes in SEP or rCBF, suggesting that well-developed collateral circulation immediately improved cerebral hemodynamics in the ipsilateral hemisphere. These results suggest that NIRS can provide direct and valuable information on cerebral hemodynamic changes during carotid artery balloon occlusion.

Aged↗
PubMed1996

Angiographic analysis of moyamoya disease--how does moyamoya disease progress?

Differences in the clinical presentation and angiographic stages of moyamoya disease were studied in 69 patients, 35 children (6.3 +/- 2.9 years old) and 34 adults (44.6 +/- 10.5 years old). The angiographic stage (Suzuki's stage) was compared between childhood and adulthood, ischemic onset and hemorrhagic onset, and female and male. The distribution of the angiographic stage was not very different, but was significantly shifted from stage III to stage IV in adult cases. The angiographic stage in patients with hemorrhagic onset was not significantly different from those with ischemic onset. There was no significant difference between females and males. Angiographic change is not very remarkable between pediatric and adult moyamoya disease. The angiographic stage does not directly correlate with the distinct clinical presentations between pediatric and adult moyamoya disease. Other factors such as cerebral blood flow demand and arteriosclerotic change seem to cause these differences.

Adolescent↗
PubMed1996

Spontaneous disappearance of arteriovenous malformation during staged treatment of multiple cerebral arteriovenous malformations--case report.

A 36-year-old male presented with aphasia and right hemiparesis due to the rupture of the larger of two arteriovenous malformations (AVMs) coexisting in the left hemisphere. The two AVMs had completely separate locations and different feeding arteries and draining systems. Two months after resection of the larger AVM and evacuation of the hematoma, carotid angiography showed the residual AVM had spontaneously disappeared. He was discharged without deficits. Change of cerebral hemodynamics after removal of the larger AVM presumably caused the spontaneous regression of the smaller one. Cerebral angiograms should be carefully examined because cerebral hemodynamics may be altered after removal of an AVM.

Adult↗
PubMed1996

Ruptured aneurysm of the middle meningeal artery associated with occlusion of the posterior cerebral artery. Case report.

The authors describe the case of a 69-year-old man with an intracerebral hemorrhage due to rupture of a nontraumatic aneurysm of the middle meningeal artery (MMA). The ipsilateral posterior cerebral artery (PCA) was occluded, and dural anastomoses developed as the main collateral pathway between the MMA and the cortical branch of the PCA, on which the aneurysm was located. It is considered that increased hemodynamic stress to the collateral pathway contributed to the formation of the aneurysm.

Aged↗
PubMed1996

Is "unilateral" moyamoya disease different from moyamoya disease?

Whether a diagnosis of moyamoya disease is justified in patients with typical angiographic evidence of moyamoya disease unilaterally and normal angiographic findings contralaterally remains controversial. In this study the authors analyzed longitudinal angiographic change, familial occurrence, and basic fibroblast growth factor (bFGF) concentration in the cerebrospinal fluid (CSF) of patients with "unilateral" moyamoya disease. Over a 10-year period, 10 cases of unilateral moyamoya disease were followed using conventional angiography or magnetic resonance angiography. Basic FGF in CSF, obtained from the subarachnoid space of the cerebral cortex during revascularization surgery, was measured in five cases. Among the 10 cases of unilateral moyamoya disease, only one pediatric case showed obvious signs of progression to typical bilateral disease. The other nine cases (including six adults and three children) remained stable throughout follow-up radiological examinations (magnetic resonance angiography) with a mean observation period of 3.5 years. There was no familial occurrence in these cases of unilateral moyamoya disease. Levels of bFGF, which are high in typical moyamoya disease, were low in these patients. The progression from unilateral moyamoya disease to the typical bilateral form of the disease appears to be infrequent. The low levels of bFGF in the CSF of these patients and the lack of familial occurrence strongly suggest that most cases of unilateral moyamoya disease, especially those found in adults, are distinct from typical bilateral moyamoya disease.

Adolescent↗