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Biomedical subjects

Kaoru Kurisu

Publications and source records attributed to Kaoru Kurisu.

At least 37 records · Page 2Linked to original sources
PubMed2005

Churg-Strauss syndrome presenting with subarachnoid hemorrhage from ruptured dissecting aneurysm of the intracranial vertebral artery.

Churg-Strauss syndrome (CSS) represents a rare systemic vasculitis that is almost invariably accompanied by bronchial asthma and eosinophilia. We report a case of a 36-year-old woman with previously diagnosed CSS presented with subarachnoid hemorrhage (SAH) from dissecting aneurysm in a vertebral artery (VA). Two months before onset of SAH, the patient had presented with numbness on her right lower leg due to peripheral neuropathy. On admission, angiography revealed dissecting aneurysm of the right intracranial VA and stenosis of the basilar artery. Hematological examination revealed an increased percentage of eosinophils. Ruptured dissecting aneurysm of the intracranial VA was diagnosed. Emergent coil embolization of the dissecting aneurysm and occlusion of the parent artery was performed to prevent repeated hemorrhage from the dissecting aneurysm. Then pharmacotherapy with prednisone was initiated for CSS. The patient recovered well and was discharged without any neurological deficit. As far as we know, this is the first reported case of CSS presented with SAH from dissecting aneurysm on posterior circulation.

Adult↗
PubMed2005

Malnutrition and nonthyroidal illness syndrome after stroke.

In the present study, nonthyroidal illness syndrome (NTIS), which is characterized by reduction of serum triiodothyronine (T3) without elevation of thyroid-stimulating hormone (TSH), was induced by protein-energy malnutrition (PCM). Protein-energy malnutrition is a common condition and is associated with worse clinical outcome in stroke patients admitted to a rehabilitation service. However, little is known about NTIS in stroke patients. Therefore, we studied the effects of PCM and NTIS on functional dependence in 51 stroke patients. We examined thyroid function by measuring serum free T3 (free T3), free thyroxine (free T4), and TSH. We estimated whether patients had mild NTIS (reduction of only free T3) or serious NTIS (reduction of both free T3 and free T4), examined PCM by measuring serum albumin, calculated body mass index (BMI) from weight and height on admission, and examined disability by obtaining the functional independence measurement (FIM). The 51 patients were divided into 2 groups according to FIM score on admission (low and high). The low-FIM group was divided into 2 subgroups according to the change in FIM score during hospitalization (improved or non-improved). Hypoalbuminemia was observed in 57% of patients, underweight in 22%, and mild NTIS in 82%; serious NTIS was not observed in any patients. Albumin and BMI were significantly higher in the high-FIM group than in the low-FIM group. Serum albumin concentration and BMI significantly positively correlated with free T3. Free T3 (but not albumin or BMI) was significantly higher in the improved subgroup than in the non-improved subgroup. Nonthyroidal illness syndrome after stroke was common and was provoked by PCM, which occurred in a high proportion of functionally dependent patients. It appears that, once stroke patients develop NTIS, it is difficult to achieve functional improvement. Therefore, during the recovery period after stroke, it is important to determine whether NTIS is present and ensure proper intensive rehabilitation and nutritional management.

Adult↗
PubMed2005

A ruptured middle cerebral artery aneurysm originating from the site of anastomosis 20 years after extracranial-intracranial bypass for moyamoya disease: case report.

BACKGROUND: Direct revascularization through a superficial temporal artery-middle cerebral artery (STA-MCA) bypass is often performed to prevent ischemic or hemorrhagic attack in patients with moyamoya disease. This is the first reported case of aneurysm formation and rupture due to an STA-MCA bypass in a patient with moyamoya disease. CASE DESCRIPTION: A 52-year-old man who had undergone bilateral STA-MCA bypass for caudate hemorrhage due to moyamoya disease 20 years previously suffered from sudden-onset unconsciousness. Computed tomography revealed a massive intracerebral hematoma (ICH) in the left frontoparietal region. Angiography showed good patency of the anastomoses and stage IV moyamoya disease. However, no other abnormality was found. Emergency evacuation of the hematoma was performed. The patient's postoperative course was uneventful, but consciousness disturbance of sudden onset occurred 1 month later. Computed tomography showed a hematoma in the lateral ventricle and acute hydrocephalus. Repeat angiography revealed an aneurysm on the left side of the anastomosis. Bilateral ventricle drainage tubes were inserted, and the aneurysm was clipped. A ventriculoperitoneal shunt was later performed. CONCLUSION: In patients with moyamoya disease who have undergone extracranial-intracranial bypass surgery, progressive hemodynamic stress may cause the formation of de novo aneurysms after a postoperative period of several decades. Imaging examinations should therefore be performed periodically for follow-up, and a de novo aneurysm should be suspected in a patient who has an unusual ICH.

Anastomosis, Surgical↗
PubMed2005

Staged bilateral vertebral artery occlusion for ruptured dissecting aneurysms of the basilar artery: a report of 2 cases.

BACKGROUND: Dissecting aneurysm of the basillary artery BA is rare. Although mortality rate is high, management remains controversial. We report 2 cases of dissecting aneurysm of the BA presenting with subarachnoid hemorrhage (SAH), both of which were successfully treated using staged occlusion of bilateral vertebral arteries (VAs). CASE DESCRIPTION: A 64-year-old man and a 34-year-old woman presented with SAH associated with ruptured dissecting aneurysm of the BA. After endovascular occlusion of a single VA, blood flow in the dissected lumen was reduced. However, one aneurysm rebled and the bleb of the other did not change. Vertebral arteries were also occluded using endovascular techniques at 4 and 2 weeks after initial treatment, respectively. On the second intervention, stump pressure ratios of VAs intended for occlusion were 62.5% and 50.6%, respectively. The patients tolerated temporary occlusion of bilateral VAs well. Subsequent permanent occlusion of bilateral VAs resulted in no neurological complication. Complete obliteration of the aneurysmal lumen was demonstrated on magnetic resonance angiography performed 72 and 5 months later, respectively. CONCLUSION: Staged bilateral VA occlusion might be the last recourse to prevent further hemorrhage from BA dissecting aneurysm. The technique can be safely applied when the stump pressure ratio is 50.6% or greater and when the patient tolerates temporary occlusion, which suggests the existence of sufficient collateral flow from the anterior circulation.

Adult↗
PubMed2005

Slow postoperative decline in blood concentration of insulin-like growth factor-1 (IGF-1) in acromegalic patients.

Recent criteria for cure of acromegaly require normalization of the insulin-like growth factor (IGF-1) level. A retrospective study was conducted to assess postoperative sequential changes in the blood IGF-1 level and to determine the appropriate timing for endocrinologic assessment of the effect of surgery. Blood IGF-1 levels were measured at least 3 times (4.9 +/- 2.0, mean +/- SD) during the first postoperative year in 36 acromegalic patients whose glucose tolerance test results, obtained 3 months after surgery, showed the growth hormone level to be suppressed to under 1 ng/mL. Postoperative IGF-1 parameters, i.e. the actual IGF level and %IGF-1 compared to the nadir during the first postoperative year, rapidly decreased during the first 2 postoperative weeks and then slowly declined over the next 2 weeks. They reached a plateau (stable nadir) during the 2nd postoperative month. Assessment of the postoperative endocrinologic status should be delayed at least one month after surgery in acromegalic patients.

Acromegaly↗
PubMed2005

Hypothalamic hamartoma.

The incidence of hypothalamic hamartomas (HHs) has increased since the introduction of magnetic resonance (MR) imaging. The etiology of this anomaly and the pathogenesis of its peculiar symptoms remain unclear, but recent electrophysiological, neuroimaging, and clinical studies have yielded important data. Categorizing HHs by the degree of hypothalamic involvement has contributed to the accurate prediction of their prognosis and to improved treatment strategies. Rather than undergoing corticectomy, HH patients with medically intractable seizures are now treated with surgery that targets the HH per se, e.g. HH removal, disconnection from the hypothalamus, stereotactic irradiation, and radiofrequency lesioning. Although surgical intervention carries risks, total eradication or disconnection of the lesion leads to cessation or reduction of seizures and improves the cognitive and behavioral status of these patients. Precocious puberty in HH patients is safely controlled by long-acting gonadotropin-releasing hormone agonists. The accumulation of knowledge regarding the pathogenesis of symptoms and the development of safe, effective treatment modalities may lead to earlier intervention in young HH patients and prevent the decline in their cognitive abilities and quality of life. This review of hypothalamic hamartomas presents current classifications, pathophysiologies, and treatment modalities.

Hamartoma↗
PubMed2005

Solitary brain metastasis from renal cell carcinoma 15 years after nephrectomy: case report.

A 77-year-old man presented with a metastatic brain tumor 15 years after nephrectomy for a renal cell carcinoma. Neurological examination showed recent memory disturbance and slight right hemiparesis. Magnetic resonance imaging revealed a round well-demarcated mass extending from the left thalamus to the left trigone of the lateral ventricle. Preoperative angiography showed tumor staining. Surgery was performed by opening the inferior temporal sulcus. Only biopsy could be performed because of extensive bleeding from the tumor. Histological examination identified metastatic renal cell carcinoma. Gamma knife surgery was performed which resulted in resolution of his hemiparesis. Metastatic renal cell carcinoma should be considered even if nephrectomy was performed 10 or more years before presentation.

Aged↗
PubMed2005

Simultaneous cranial and spinal subdural hematoma.

A 59-year-old male presented with spinal subdural hematoma (SDH) with concomitant cranial chronic SDH manifesting as mild paraparesis and numbness in both lower extremities. Magnetic resonance (MR) imaging showed simultaneous occurrence of cranial and spinal SDHs. The patient was treated conservatively because of poor medical condition and mild neurological symptoms, and recovered well within 1 month. Serial follow-up MR imaging revealed spontaneous resolution of both lesions, with signal intensity changes suggesting the degenerative process of subacute hematoma. The spinal hematoma may have migrated from the cranial lesion. Spinal SDH is a potential sequela of chronic SDH in the cranium.

Hematoma, Subdural, Intracranial↗
PubMed2005

Reconstruction of pterional key hole using three-dimensional titanium plate: technical note.

Patients who have undergone pterional craniotomy sometimes complain about postoperative cosmetic impairment in the frontotemporal area. This problem occurs as a result of inappropriate repair or no repair of the pterional key hole. The authors have developed an intraoperative hand-made three-dimensional titanium plate, and as a result of using this plate the postoperative cosmetic appearance was satisfactory.

Bone Plates↗
PubMed2005

Volume subtraction three-dimensional CT angiography for cerebrovascular disease: report of two cases.

We report two cases in which volume subtraction three-dimensional CT angiography (VS-3DCTA) was used for cerebral aneurysm and vascular stenosis with intramural calcification. Case 1: VS-3DCTA with volume rendering clearly showed carotid cave aneurysm of the internal carotid artery. The location and size of the aneurysm was confirmed by digital subtraction angiography (DSA). In evaluation of the aneurysm, VS-3DCTA was equal to DSA and endovascular findings. Case 2: VS-3DCTA with volume rendering clearly showed stenosis of the middle cerebral artery, and intramural calcification with the cause of the stenosis was subtracted. On the other hand, it was difficult for DSA to reveal the stenosis because of the limitation of the imaging angle. In evaluation of the stenosis, VS-3DCTA was superior to DSA. VS-3DCTA was an important diagnostic tool that enabled visualization of the aneurysm in the area of the skull base and stenosis of the intracerebral artery.

Aged↗
PubMed2004

Spontaneous regression of Langerhans cell histiocytosis: a case report.

BACKGROUND: Spontaneous regression of Langerhans cell histiocytosis (LCH) has been reported in skin, bone, and pulmonary lesions. However, such phenomena in the central nervous system (CNS) have not been described previously. CASE DESCRIPTION: A case of LCH in the CNS with spontaneous regression is reported. A 2-year-old boy presented with general convulsion followed by frequent vomiting and diabetes insipidus. Magnetic resonance imaging (MRI) scan revealed numerous multifocal nodules predominantly in the left frontal lobe. The patient underwent surgery to remove part of the frontal lesion. Subsequent to surgery, residual lesions showed regression without any additional treatment, and clinical symptoms also subsided. The multiple lesions disappeared completely and did not relapse during 5-year observation. CONCLUSION: Surgical resection and/or adjuvant therapy such as radiation and chemotherapy has been performed for the treatment of LCH in the CNS. However, there may be a subgroup of patients with multifocal brain LCH that regress spontaneously. Further clinical study is required to establish the natural course and prognostic factors of this disease.

Brain Diseases↗
PubMed2004

Infundibuloneurohypophysitis presenting a large sellar-juxtasellar mass: case report.

BACKGROUND: Infundibuloneurohypophysitis (INH) is reported to be a self-limiting inflammatory disease involving neurohypophysis. The authors experienced a case of INH presenting a large mass compressing the brain stem. CASE PRESENTATION: The patient exhibited polyuria followed by left hemiparesis and dysarthria lasting a year. Magnetic resonance imaging showed a large sellar mass extending into the right cavernous sinus and prepontine cistern and compressing pons. Endocrinologically, diabetes insipidus was diagnosed and anterior pituitary function was almost normal. Microscopic examination of the surgical specimen obtained by a transsphenoidal route demonstrated diffuse infiltration of lymphoid cells with predominance of B cells over T cells and the granulation tissue. The patient underwent 40 Gy local radiation because of initial misinterpretation of histologic findings as malignant lymphoma and short-term corticostertoid administration. CONCLUSION: The mass gradually shrank and the patient has become neurologically intact in 6 months. At this moment, 67 months after the onset, the patient is free from disease and has no other lesion. INH seems to be a clinical entity possessing a wide spectrum from infundibular tumorlet to an aggressive sellar mass trespassing on surrounding structures.

Biopsy↗
PubMed2004

Vancomycin ointment for MRSA infection at a cranioplasty site.

OBJECTIVE: To report a case illustrating therapeutic success with long-term topical application of aseptic vancomycin ointment to treat methicillin-resistant Staphylococcus aureus (MRSA) infection at a cranioplasty site. CASE SUMMARY: A 63-year-old Japanese woman underwent evacuation of a subdural hematoma complicated by subarachnoid hemorrhage. Subsequent craniotomy for clipping and external decompression of an aneurysm of the neck was followed by cranioplasty using an autologous bone graft. The graft became infected with MRSA, which responded to intravenously infused vancomycin. The graft was then replaced with a ceramic implant. The implant site became reinfected with MRSA. Vancomycin infusion failed on this occasion, despite a favorable in vitro sensitivity test. After obtaining patient consent, investigative treatment was begun using long-term aseptic application of vancomycin 2.5% ointment, resulting in control of the infection and negative cultures. DISCUSSION: The care of an infection at the site of cranioplasty with a ceramic artificial bone implant is difficult. Our patient's infection resolved with the use of vancomycin ointment. In this case, blood concentrations of vancomycin remained below detectable levels, and no adverse effects resulted from application of vancomycin ointment. CONCLUSIONS: Topical administration of vancomycin was more effective than systemic administration in the treatment of our patient's MRSA skull implant infection. No adverse effects from topical treatment were encountered over 3 years.

Administration, Topical↗
PubMed2004

Relationship between intratumoral hemorrhage and overexpression of vascular endothelial growth factor (VEGF) in pituitary adenoma.

The authors investigated the relationship between hemorrhage and the expression of vascular endothelial growth factor (VEGF) in pituitary adenomas. The subjects were 39 patients with pituitary adenomas. Surgically obtained tumor tissue was immunohistochemically stained using antibodies against VEGF, CD-34, Ki-67, and anterior pituitary hormones. The expression of VEGF was graded as 0, 1+, and 2+. The relationship between intratumoral hemorrhage and factors such as tumor size, Ki-67 labeling indices, number of CD-34 positive vessels, and VEGF expression was examined by multivariate analysis. High-grade VEGF expression was the sole independent factor correlated with intratumoral hemorrhage. The number of CD-34 positive vessels had no effect on the incidence of hemorrhage in patients with pituitary adenomas. In conclusion, a positive relationship between VEGF expression and hemorrhage in pituitary adenoma was observed. The patho-mechanical significance of this correlation is under investigation.

Adenoma↗
PubMed2004

Chest wall schwannoma associated with neurofibromatosis 2--a case report.

We report a rare case of neurofibromatosis type-2 (NF-2) associated with a chest wall schwannoma that was initially suspected of being a breast tumor. The patient was a 28-year-old female who was diagnosed as having NF-2 at 19 years old. At that time, she noticed a mass in the upper lateral region of her left breast but did not have it examined. The mass grew and became painful, and she was therefore referred to our department. Results of the initial examination indicated the possibility of a breast tumor, but a diagnosis of extramammary tumor of the major pectoralis major muscle was made on the basis of the results of ultrasonography and 3-dimensional computed tomography (3D-CT). An endoscope-assisted extirpation of the tumor was performed. Histologically, the tumor was an Antoni type A and B neurilemoma and was diagnosed as a schwannoma.

Adult↗