Biomedical subjects

T Itakura

Publications and source records attributed to T Itakura.

At least 73 records · Page 4Linked to original sources

PubMed1998

[Thoracic arachnoid cyst presenting incomplete features of Brown-Séquard syndrome: a case report].

Spinal intradural arachnoid cyst presenting incomplete features of Brown-Séquard syndrome is very rare. Only 6 cases have been reported. We report one in a thoracic lesion. A 42-year-old man noticed thermohypesthesia in his right leg, and monoparesis in his left leg. On admission, he presented incomplete features of Brown-Séquard syndrome below the Th7 level. MRI showed the spinal cord to be displaced antero-laterally to the right at Th6-7 level. Myelography and CT myelography failed to show the cyst wall, but an arachnoid cyst was totally removed with T5-8 osteoplastic laminotomy. Sensory disturbance has not changed postoperatively, but motor weakness in his left leg recovered within one month after the operation. No cystic lesion has been detected by MRI during the ten months since the operation. We investigated all seven cases in the literature including our case which showed incomplete features of Brown-Séquard syndrome. As regards to the location of the cyst, all cases were at the mid-thoracic level. And four cases were at the midline. These results suggest that the mechanism of Brown-Séquard syndrome associated with spinal arachnoid cyst may be related not only to the laterality of the lesion but also to the asymmetrical circulation in the watershed area.

Adult↗

PubMed1997

Metabolic inhibition enhances selective toxicity of L-DOPA toward mesencephalic dopamine neurons in vitro.

Recent in vitro studies have described the toxicity of levodopa (L-DOPA) to dopamine (DA) neurons. We investigated whether metabolic inhibition with rotenone, an inhibitor of complex I of the mitochondrial respiratory chain, may enhance the toxicity of L-DOPA toward DA neurons in mesencephalic cultures. The uptakes of DA and GABA were determined to evaluate the functional and morphological integrity of DA and non-DA neurons, respectively. Pretreatment with rotenone significantly augmented the toxic effect of L-DOPA on DA neurons. Interestingly, prior metabolic inhibition with rotenone rendered DA cells susceptible to a dose (5 microM) of L-DOPA that otherwise exhibited no toxic effect. DA uptake was more intensely attenuated than GABA uptake after the combined exposure to rotenone and L-DOPA. This was confirmed by cell survival estimation showing that tyrosine hydroxylase-positive DA cells are more vulnerable to the sequential exposure to the drugs than total cells. The selective toxic effect of L-DOPA on rotenone-pretreated DA neurons was significantly blocked by antioxidants, but not antagonists of NMDA or non-NMDA glutamate receptors. This indicates that oxidative stress play a central role in mediating the selective damage of DA cells in the present experimental paradigm. Our results raise the possibility that long-term L-DOPA treatment could accelerate the progression of degeneration of DA neurons in patients with Parkinson's disease where potential energy failure due to mitochondrial defects has been demonstrated to take place.

6-Cyano-7-nitroquinoxaline-2,3-dione↗

PubMed1997

The effect of endovascular therapy for cerebral arterial spasm, its limitation and pitfalls.

PURPOSE: The effect of endovascular treatment for vasospasm was investigated by analysing the results of patients treated in Wakayama City in 1994. MATERIALS AND METHODS: Ninety nine patients with ruptured cerebral aneurysms, who survived more than one week and were treated in Wakayama City in 1994, were studied. Twenty five patients caused symptomatic vasospasm and 25 were treated by endovascular therapy, percutaneous transluminal angioplasty (PTA) and/or intra-arterial papaverine infusion (IAP). PTA was performed for proximal vasospasm which located in the main arterial trunk, such as ICA, M1, BA (n = 3). IAP was chosen for distal vasospasm which located mainly in the M2, A1, A2 (n = 12). PTA and/or IAP was performed for diffuse vasospasm which located in proximal and distal arteries (n = 10). RESULTS: In the proximal vasospasm group, all patients were good to moderately disabled on the Glasgow outcome scale (GOS). In the distal vasospasm group, 8 patients were good to moderately disabled, and 4 patients were severely disabled. The overall results were as follows: 17 (68%), good to moderately disabled, 4 (16%), severely disabled, 4 (16%), dead. The morbidity and mortality rate was 8/25 (32%) in symptomatic spasm group. CONCLUSION: PTA was very effective especially for proximal vasospasm, but IAP was not always effective for distal or diffuse vasospasm. Diffuse vasospasm revealed a high mortality rate in spite of the endovascular therapy.

Adult↗

PubMed1997

Is unilateral spatial neglect a single phenomenon? A comparative study between exploratory-motor and visual-counting tests.

The aim of this study is to report the preliminary findings of a traditional battery of tests and our original battery capable of assessing the presence of components and extent of lesions in patients with unilateral spatial neglect. Thirty patients who had unilateral spatial neglect with a stroke in the right hemisphere were assessed for unilateral spatial neglect on exploratory-motor (E-M) tasks, visual-counting (V-C) tasks, and traditional neglect batteries at least 4 weeks after the onset. Other neuropsychological tests and computed tomography were also performed to investigate the relationship with neglect. A factor analysis showed that our tasks loaded significantly on three factors. E-M neglect was found in 16 patients, and V-C neglect in 22 patients with unilateral spatial neglect. There were high correlations between E-M neglect and motor paralysis, word fluency, backward digit span and motor impersistence. There were high correlations between V-C neglect and visual-field defect, line bisection, line cancellation and figure copying. Lesions in the frontal lobe, caudate, insula, and anterior portion of the paraventricular white matter were commonly associated with E-M neglect. Lesions in the occipital lobe were also associated with V-C neglect. We suggest that unilateral neglect is not a single phenomenon, but rather involves several different components. We propose that E-M and V-C tasks are useful methods for evaluating the extent of lesions in patients with unilateral spatial neglect.

Adult↗

PubMed1997

Cerebral angioplasty in a patient with vascular dementia.

A 66-year-old man with a history of previous transient ischemic attacks had progressive memory and gait disturbance caused by severe stenoses of both the internal carotid arteries and vertebral arteries. The patient underwent percutaneous transluminal angioplasty of the vertebral arteries and endarterectomy of the internal carotid arteries with satisfactory results. On admission, the patient was alert, but disoriented to time and place. He exhibited mild motor weakness in both legs. Neuropsychological tests revealed remarkable intellectual deterioration and he required maximum support to perform activities of daily living. Higher cortical function and the ability to perform activities of daily living improved remarkably after the angioplasty. Angioplasty is an alternative therapy to reverse functional deficits in patients with cerebrovascular hemodynamic compromise.

Aged↗

PubMed1997

Buccofacial apraxia and left cerebral haemorrhage.

We examined 33 patients with left intracerebral haemorrhage to investigate the relations to buccofacial apraxia (BFA). BFA was present in 18 cases at 1 month and disappeared in 3 cases and persisted in 15 cases at 6 month from the onset. The existence of BFA seems to be partially dependent the haematoma volume which may cause the organic damage in lenticulate nucleus, insula, posterior limb or internal capsule and anterior portion of paraventricle white matter. All patients with BFA had aphasia (Broca 6, Wernicke 1, Total 10, Amnestic 1). Aphasia of the patients with transient BFA improved as well as the patients without BFA after BFA disappeared. We suspected that improvement or aphasia might be affected by BFA.

Aphasia↗

PubMed1997

Rehabilitation of patients with anosognosia for hemiplegia due to intracerebral haemorrhage.

We have studied the differences in the lesions, concomitant symptoms and ADL levels in patients in acute-stage cerebral-haemorrhage and manifesting anosognosia. Twelve of 50 patients (24.0%) presented with anosognosia. The (+) group had longer intervals between onset and the first evaluation than did the (-) group, demonstrating severe sensory disturbance. The volume of haemorrhage was significantly larger in the (+) group. Anosognosia disappeared within 3 months in all cases. In the (+) group the time until discharge was long, with the ADL level at the time of discharge being low. Therefore, it was considered that anosognosia was important as an inhibitory factor hampering rehabilitation.

Activities of Daily Living↗

PubMed1997

Impairment of short-term memory in left hemispheric traumatic brain injuries.

We report on two patients with traumatic lesions in the temporal and parietal lobes who demonstrated disturbances of short-term memory (STM) following improvement on the aphasia. Patient 1 was a 66-year-old right-handed man who presented to our hospital with a cerebral contusion. One admission we observed a Wernicke's aphasia with paraphasic jargon in this patient that resolved within 8 weeks. Patient 2 was a 35-year-old right-handed woman, with an acute subdural haematoma and a cerebral contusion, who underwent craniotomy and evacuation of the haematoma. In this patient we noted a transient Wernicke's aphasia following the operation that improved within 3 months. Linguistically, the aphasia observed in each of these two patients was not a typical conduction aphasia because of the absence of paraphasia, and impairment of comprehension was unclear despite a decrease in performance on repetition tasks. Both verbal and non-verbal tasks suggested an impairment in STM. These findings suggest that involvement of the left hemisphere may cause disturbances in both verbal and non-verbal STM.

Adult↗

PubMed1997

Exploratory-motor task to evaluate right frontal lobe damage.

An exploratory-motor (E-M) task was performed by 20 patients with right hemispheric damage and unilateral spatial neglect and by 15 adult controls. None of the subjects in the control group demonstrated E-M neglect, other types of unilateral spatial neglect, or motor impersistence. In the unilateral spatial neglect group, 14 of 20 patients revealed E-M neglect. The presence or absence of E-M neglect related to word fluency, digit span recall (backward), and motor impersistence. In addition, E-M neglect frequency was observed in patients with lesions in the frontal lobe. The frontal lobe may play an important role in the performance of an E-M task. Therefore, we think that E-M task performance is a useful method for evaluating the site of right frontal lobe damage.

Adult↗

PubMed1997

Subdural and meaningful involvement related to Wegener's granulomatosis: case report.

OBJECTIVE AND IMPORTANCE: The first case of Wegener's granulomatosis associated with subdural empyema is presented. CLINICAL PRESENTATION: A 37-year-old man was admitted to our hospital for treatment of bilateral subdural masses. Magnetic resonance imaging demonstrated strong bilateral subdural and meningeal enhancement. The patient was treated with subdural drainage, based on the diagnosis of bilateral subdural hematoma or empyema as revealed by magnetic resonance imaging. Even after surgery, he developed systemic symptoms that are typical for Wegener's granulomatosis, including hemosputum, papules, peripheral nervous disorders, hematuria, myalgia, and joint pain. A diagnosis of Wegener's granulomatosis was confirmed by positive circulating antineutrophil cytoplasmic antibodies and histological findings from the skin and nasal mucosa. We diagnosed the subdural masses as Wegener's granulomatosis from the laboratory and neuroimaging studies, retrospectively. INTERVENTION: Pus-like fluid containing hematoma with negative micro-organism was evacuated by surgery. CONCLUSION: Wegener's granulomatosis should be suspected in young patients with pulmonary symptoms and subdural hematoma without head injury. This is the first case of Wegener's granulomatosis associated with subdural masses.

Adult↗

PubMed1997

Transplantation of autologous sympathetic ganglion into the brain with Parkinson's disease. Long-term follow-up of 35 cases.

Transplantation of autologous sympathetic ganglion was performed in 35 patients with Parkinson's disease. Approximately half the patients showed improvement of parkinsonian symptoms over the 3 years following transplantation. The patients showed amelioration of bradykinesia and gait disturbance, but tremor and muscle rigidity were not improved by transplantation. The other half of the patients did not show amelioration after transplantation. No serious complications were encountered, though mild ptosis was observed in all patients. The mechanism of improvement of symptoms might be the release of dopamine from the grafted sympathetic ganglion. Transplantation of autologous sympathetic ganglion can be a therapeutic modality for Parkinson's disease.

Adult↗

PubMed1997

Iatrogenic arteriovenous fistula of the middle meningeal artery caused during embolization for meningioma--case report.

A 73-year-old female developed middle meningeal arteriovenous fistula during embolization of a falx meningioma. The cause of this complication was thought to be perforation by the guide wire during catheterization at the sharp bend in the sphenoidal portion of the middle meningeal artery. Embolization of the fistula and the feeding artery to the meningioma with polyvinyl alcohol particles 250-355 microns size resulted in complete obliteration of the fistula. Computed tomography showed no epidural or subdural hematoma. Introduction of the microcatheter beyond the sharp bend in the middle meningeal artery should not be attempted to avoid the possibility of iatrogenic middle meningeal arteriovenous fistula.

Aged↗

PubMed1997

Functional outcome following thalamic haemorrhage: relationship between motor and cognitive functions and ADL.

Twenty-two patients with thalamic haemorrhage were examined to investigate the relationship between motor and cognitive function, and activities of daily living (ADL). Patients with unilateral spatial neglect had lower ADL scores on admission than patients without unilateral spatial neglect (Mean: 17.0 and 24.6, respectively; F = 4.38, df = 1, p < 0.05). Unilateral spatial neglect related to feeding, bowel control and transfer in Barthel index on admission. Patients with aphasia on admission had lower ADL at discharge than patients without aphasia on admission (Mean: 57.0 and 84.7, respectively; F = 7.70, df = 1, p < 0.05). Aphasia related to the bathing, toilet, stair climbing, dressing, and ambulation in Barthel index on discharge. There was a significant difference between the severity of paresis in upper and lower limb on admission and ADL at discharge. The two-way repeated measures ANOVA showed a significant difference between severity of paresis in lower limb and ADL improvement. It can be suggested that the most important predictor of outcome was paresis in lower limb, and not aphasia or unilateral spatial neglect.

Activities of Daily Living↗

PubMed1997

[Syringomyelia appearing in a short term after brain abscess].

We describe a rare case of syringomyelia that developed within only 4 months after the cure of the focal cerebritis and abscess. An 18-year-old man who had suffered from meningitis and brain abscess 1.5 years before, presented with pain and sensory disturbance in his left shoulder. Magnetic resonance image (MRI) showed a syrinx formation extending from the upper cervical to the lower thoracic cord. Investigation by MRI during the course of the brain abscess had the appearance of posterior cerebellar arachnoid cyst 3 months after the onset of brain abscess and syrinx developed within 9 months. After posterior fossa decompression and reopening of the Magendie's foramen, his symptom and MRI abnormality improved after one month. In contrast to reported cases of syringomyelia following cerebritis, syrinx formation in our case appeared in relatively a short time. We speculated that basal arachnoiditis and the formation of posterior cerebellar arachnoid cyst caused syrinx formation in a short term after cerebritis.

Adolescent↗

PubMed1997

[Spontaneous intracranial hypotension with severe headache and typical neuroradiological findings: report of two cases].

Intracranial hypotension causes the postural headache that sometimes follows lumbar puncture. When postural headache and associated symptoms occur after lumbar puncture, the diagnosis is usually obvious. However, similar symptoms may occur after minor trauma or without an obvious precipitating cause (spontaneous intracranial hypotension: SIH). SIH is rare, but is now increasingly recognized as a cause of postural headache. We encountered two cases of SIH showing typical neuroradiological findings. Case 1 is a 47-year-old man who was admitted with severe frontalgia. CT scan revealed vague visualization of bilateral Sylvian fissures and slit ventricles. Spinal fluid pressure was 6cm H2O in the lateral recumbent position. Cerebrospinal fluid (CSF) showed slight lymphocytic pleocytosis. We treated him as having viral meningitis. His headache improved gradually and he was discharged 2 weeks later with slight occipitalgia. One week after discharge, he complained of severe headache again and plain CT showed bilateral subdural hematoma. The subdural hematoma in both sides was evacuated and his headache improved after the operation. Follow-up CT scans two months later showed normalization of ventricle size and cisterns. Case 2 is a 52-year-old woman who was admitted with severe occipitalgia. CT scan on admission showed slit ventricles and the disappearance of the suprasellar cistern and the Sylvian fissure. Spinal fluid pressure was 3cm H2O. Gd-enhanced MRI showed remarkable meningeal enhancement and effacement of the optic chiasm suggesting brain sagging. Her headache improved 2 weeks later after strict bed rest and oral pain relief drugs. The follow-up MRI showed disappearance of abnormal meningeal enhancement and normalization of optic chiasma effacement. SIH is one of the important differential diagnoses of patients complaining of postural headache. Meningeal enhancement of gadolinium-enhanced MRI is an important finding to diagnose SIH. We have to consider SIH when diagnosing postural headache.

Brain↗

PubMed1997

[A case of cerebral aneurysm using a goose neck snare to stabilize the guiding catheter during embolization].

Severe arteriosclerotic changes often prevent navigating a guiding catheter into an appropriate position during aneurysm embolization. A basilar superior cerebellar artery aneurysm was found in a patient who had had subarachnoid hemorrhage 6 months previously. We selected embolization for this aneurysm using Guglielmi detachable coils (GDC) because of its highly located position from the dorsum sellae. We could not introduce a guiding catheter into the distal portion of the vertebral artery because of severe arteriosclerotic changes and it easily prolapsed into the aorta when a microcatheter was navigated through the guiding catheter positioned in the proximal vertebral artery. We were able to successfully perform embolization of the aneurysm by fixing a guiding catheter at the origin of the left vertebral artery with a goose neck snare wire introduced from the left brachial artery. The authors emphasize that a snare wire is useful not only for retrieval of foreign bodies but also for fixing a guiding catheter during aneurysm embolization, especially in which prolapse of the guiding catheter may cause a serious complication.

Catheterization↗

PubMed1997

[Studies on the bottles of mineral water and the foreign plastic like substances].

The containers of mineral water and the foreign plastic substances which were found in the mineral water were investigated. Most of plastic bottles were made of polyethylene terephthalate (PET) and the caps were made of polypropylene (PP), polyethylene (PE) or aluminum. PE liners were attached to some caps. Most of the foreign plastic substances were PET while others were PE, PP, Teflon and rubber. Some bottles had a scratch on the top inside. The origin of most PET fragments was presumed to be scraped off the bottles by the lowering of the injection nozzle during the water filling process. The sources of the other substances were also determined.

Food Contamination↗

PubMed1996

Transcortical mixed aphasia with left frontoparietal lesions.

We present a case of transcortical mixed aphasia following a left frontoparietal infarct caused by vasospasm after subarachnoid haemorrhage. Although CT showed low-density areas in the left frontal lobe and basal ganglia, single photon emission CT revealed a wider area of low perfusion over the entire left hemisphere, except for the left perisylvian speech areas. Hence, transcortical mixed aphasia may be caused by the isolation of perisylvian speech areas due to disconnection from surrounding areas.

Aphasia↗