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T Kayama

Publications and source records attributed to T Kayama.

At least 127 records · Page 7Linked to original sources
PubMed1988

[A case of anaplastic astrocytoma associated with pituitary adenoma].

A case of anaplastic astrocytoma associated with pituitary adenoma is reported. The patient was a 33-year-old male, who was admitted with complaints of sensory aphasia, slight left motor paresis, and visual field defects. Neurological examination disclosed sensory and motor aphasia, Gerstmann's syndrome, slight left motor paresis, right homonymous hemianopsia, and bilateral choked discs. Computed tomography revealed a low density mass lesion with slight enhancement in the left temporal region and a ring-like enhanced mass lesion in the suprasellar region. In MRI, both the left temporal and the suprasellar lesions are depicted as low signal intensity areas in T1 weighted imaging, but as high signal intensity areas in T2 weighted imaging. Craniotomy was performed and both tumors were almost totally removed. The tumor in the left temporal region was diagnosed as anaplastic astrocytoma and the other in the suprasellar region was diagnosed as chromophobe adenoma. Multiple primary intracranial tumors of different cell types are rare. About a hundred cases can be found in medical literature. More than two thirds of them are cases of glioma associated with meningioma, but other combinations of tumors are extremely rare. We now report this case of astrocytoma associated with pituitary adenoma. In the literature, there are only 5 cases of similar combination. It is believed that astrocytoma and pituitary adenoma are histologically different. In three of five reported cases, the tumors were in close proximity to each other, but it is doubtful that their close proximity was related to the fact that they developed concurrently.

Adenoma↗
PubMed1988

[Persistent primitive first cervical intersegmental artery (proatlantal artery II) with occlusion of the basilar artery--a case report].

A rare case of persistent primitive first cervical intersegmental artery (proatlantal artery II) is reported. A 58-year-old man was admitted to our hospital with dysarthria and left hemiparesis. On admission he was stuporous with bilateral gaze palsy and left hemiparesis. CT scan on admission showed low density areas in the right cerebellar hemisphere and ventricular part of the pons. Right retrograde brachiography revealed occlusion of the basilar artery, aplasia of the right vertebral artery and an abnormal vessel connecting the right external carotid artery and the right vertebral artery. This anastomotic vessel was thought to be a persistent primitive first cervical intersegmental artery (Proatlantal artery II). Left carotid angiography revealed the left posterior cerebral artery was visualized through the posterior communicating artery, leading from the internal carotid artery. Left retrograde brachial angiography showed that the left vertebral artery terminated just distal from the branching of the left posterior inferior cerebellar artery. After admission the left hemiparesis deteriorated gradually and tracheotomy was done due to respiratory difficulties. The patient was then transferred to the rehabilitation center on his 34th day in hospital with neurological deficits.

Arterial Occlusive Diseases↗
PubMed1988

[Revascularization of vertebro-basilar occlusive disease].

Various surgical techniques have been reported for vascular reconstruction in cases of vertebro-basilar occlusive disease, but sufficient study has not been made on the question of which technique should be applied in various pathological conditions. Based on our experience, we have examined the advantages and disadvantages of these techniques. In 34 patients with clinically and angiographically diagnosed vertebro-basilar insufficiency, the reconstructive vascular surgery to the posterior circulation was performed. Preoperatively, 24 had vertebro-basilar TIAs, 2 had RIND, 3 had progressing symptoms and 5 had brain stem infarctions verified by persistent deficits. In the 18 patients with intracranial vertebro-basilar occlusive lesions, the bypass were done to the proximal posterior inferior cerebellar artery in 7 cases, proximal superior cerebellar artery in 9 cases, posterior cerebral artery in one and anterior inferior cerebellar artery in one. In the 16 patients with extracranial occlusive lesions of vertebral artery, endarterectomy or subclavian-vertebral transposition was performed. With the exception of one of the progressing stroke cases, in which the surgery was ultimately too late, there were no cases in which neurological symptoms become aggravated following operation. Patency was 94% (32/34). In light of these findings, the following conclusions concerning the operative indication and the selection of the technique have been drawn. In cases with occlusive lesions of basilar artery, the first choice should be bypass to the proximal superior cerebellar artery. In cases with occlusive lesions of vertebral artery, bypass to the posterior inferior cerebellar or superior cerebellar or anterior inferior cerebellar artery should be performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Vascular anomalies associated with anterior communicating aneurysms].

Using a bifrontal trans-interhemispheric approach, we have performed direct operations on 206 cases of aneurysm of the anterior communicating artery, 44 of which (21.4%) had vascular anomalies associated with the aneurysm. Those anomalies included 27 cases (13.1%) with median artery of the corpus callosum, 20 cases (9.7%) with duplication of the anterior communicating artery and one case (0.5%) with duplication of the A1 portion. Preoperative diagnosis of the duplications was not possible on the basis of angiograms. Moreover, preoperative diagnosis of the median artery using angiography was unambiguous in only 11 of the 27 cases (41%). The majority (81.5%) of the aneurysms of the anterior communicating artery in cases with a median artery of the corpus callosum were found to develop at the trifurcation of the anterior communicating artery, the A2 portion and the median artery of the corpus callosum.

Cerebral Angiography↗
PubMed1987

Subarachnoid hemorrhage of unknown cause.

After the institution of computed tomography (CT), 814 cases of spontaneous subarachnoid hemorrhage (SAH) were treated during a period of 6 years and 9 months (April 1978 through December 1984). In 9 (22.0%) of 41 patients whose cause of SAH was not determined by the first four-vessel study (cerebral panangiography), ruptured aneurysms were found by repeated four-vessel study. Thus, of 814 cases, only 32 (3.9%) were diagnosed as cases of unknown etiology at discharge. The 32 cases were monitored by follow-up examination for 5 to 67 months (median, 27.1 months) after onset. No recurrence of SAH was reported, and all patients were rehabilitated except 2 who suffered terminal carcinoma. A third follow-up four-vessel study was performed 8 to 44 months (median, 22.0 months) after the second study in 14 of the 16 patients with SAH initially demonstrated by CT. In 1 of these cases, an aneurysm found 9 months after the initial SAH was treated surgically. Ultimately, 31 cases (3.8%) were diagnosed as cases of SAH of unknown cause. This incidence is low when compared with those in previous reports. Because of the strict examination schedule including repeated angiography, the incidence is lower and the prognosis is relatively favorable.

Cerebral Angiography↗
PubMed1987

[Two cases of intracranial fibromuscular dysplasia whose repeated angiography disclosed progression of the lesion].

Fibromuscular dysplasia (FMD) is well known owing to the characteristic angiographical finding of a "string of beads" appearance, but intracranial involvement with this disease is extremely rare. Moreover, to our knowledge, only seven cases that had repeated angiograms disclosed progression of FMD lesion in the literature. Such cases of intracranial FMD which showed progression in the follow-up angiography are reported. Case 1: A 8-year-old boy was referred to our hospital because of aphasia and right hemiplegia following right hemiconvulsion. Left carotid angiography on the 7th day from the onset revealed a "string of beads" appearance involving the left middle cerebral artery from M1 to M2 portion. He was treated with low molecular dextran, urokinase and steroid. After these drugs were administered, his speech was normalized. A repeat left angiogram performed two months later disclosed definite increase in the degree of stenosis associated with FMD. Perivascular sympathectomy around common and internal carotid artery and superior cervical ganglionectomy on the left side carried out on the 70th day from the onset. Postoperative left carotid angiogram showed improvement of the stenosis markedly, and the motor disturbance was improved gradually. Case 2: A 34-year-old woman presented with head dullness and disorientation suddenly. Left carotid angiogram on the third day from the onset showed a "string of beads" appearance from C1 to M1 portion. Follow-up angiography three days later revealed some progression of the stenosis. Furthermore a repeat left angiogram disclosed occlusion of left internal carotid artery at the C2 portion. Left STA-MCA bypass surgery was performed on the 61st day from the onset.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Cerebral blood flow in moyamoya disease].

Regional cerebral blood flow in forty cases of moyamoya disease was investigated by intravenous 133Xe injection method. Twenty-one cases were children and other nineteen were adults. No or only slight neurological deficit were found at the CBF studies. CBF was calculated by initial slope index. For investigation of the relation between hemispheric blood flow and age, the regression curve was calculated and that with highest correlation was chosen. In normal group, the relationship between hemispheric CBF and age was correlated to following equation: y = 146.5-58.4 log x (r = -0.903). In contrast, in moyamoya disease, it was correlated to following equation: log y = 2.04-0.23 log x (r = -0.730). It can be said that CBF of the whole brain in moyamoya disease is below normal. The distribution of the rCBF was characteristic in moyamoya disease. There are low CBF values in the frontal and temporal lobes and relatively high values in the occipital lobes as compared with normal CBF distribution. These results are thought to indicate the importance of blood circulation to the brain from the vertebro-basilar arterial system. Moreover a comparison of these CBF results with the six stages of basal moyamoya seen angiographically was investigated in child cases. As the stage of moyamoya disease progressed, the hemispheric CBF decreased gradually and the distribution of blood flow gradually changed from a predominance of flow to the frontal lobes to a predominance of flow to the occipital lobes.

Adolescent↗
PubMed1987

[Regional cerebral blood flow in children--normal value and regional distribution of cerebral blood flow in childhood].

The changes in CBF and rCBF through the entire age range include the rapid period in childhood was reported. Sixteen children between the ages of 1 and 15 and 14 adults were studied. These 30 subjects were either volunteers of out-patients without CT and EEG abnormalities. rCBF was measured by the 133Xe intravenous injection method using Varmet rCBF analyzer. Ther relationship between age and CBF, the correlation coefficient was calculated based on the regression equations and the regression curve with the highest correlation was chosen. For the analysis of rCBF, he mean rCBF values (ISI) of 3 channels corresponding to the frontal, temporal, parietal and occipital lobes were expressed as a percentage of the hemispheric CBF. The hemispheric blood flow (ISI and CBF gray) of children less than 5 years of age was approximately twice that found in adults. This value decreased rapidly with age and in the 10-15 years the blood flow was approximately 1.3-fold that of adults. Thereafter, there was a slow decrease and a negative correlation with age was found. The decrease showed the correlation on the following equations; y = 146.5 - 58.5 log x. (r = -0.903) for ISI and log y = 2.26 - 0.29 log x. (r = -0.881) for CBF gray, which was statistically significant. In contrast, the CBF white showed a slightly higher value in the 1-2 years old children, but thereafter the CBF did not show a notable decreases with age. Through the entire age range, a best fit for the Fw values was found with : y = 18.3 + 37.5/x. (r = 0.798), which was also statistically significant.

Adolescent↗
PubMed1986

Treatment of cerebral arteriovenous malformation.

The management of cerebral arteriovenous malformation (AVM) is discussed. A series of 231 cases of AVM was treated from 1961 to March 1984 in our department. The treatments of these cases are classified as total removal 169, partial removal 8, feeder clipping 14, embolization 4 and conservative 36. Results at discharge and at follow-up are analyzed and the treatment evaluated. At follow-up, no rebleeding is reported in the patients who had undergone extirpation. Cases treated with other methods showed rebleedings and either their condition worsened due to hemorrhages or they died. On the basis of these results, it is suggested that AVM should be extirpated totally. Our surgical procedure consisted of temporary occlusion of feeders using cerebral protective substances, so called "Sendai Cocktail" (mannitol, Vitamin E, steroid). This procedure makes complete surgery safe. Surgical results of the cases which were totally extirpated were better than those reported in previous reports: the mortality rate was 3.6%, and the morbidity rate was 5.4%. Because of this, surgical treatment was preferred, that is when the location, size of AVM, age, patient's circumstances and the surgeon's experience allow. However, there are still cases which must be treated with other therapy. These patients are withheld surgery because they have inaccessible AVM or large AVM etc., whose operation would cause neurological deficits. For the treatment of these cases we have recently attempt the chemical embolization method with conjugated estrogen. This produced good outcomes.(ABSTRACT TRUNCATED AT 250 WORDS)

Embolization, Therapeutic↗
PubMed1986

A case of moyamoya disease accompanied by an arteriovenous malformation.

It is well known that moyamoya disease sometimes is accompanied by cerebral aneurysm; however, no case of moyamoya disease with arteriovenous malformation has previously been published. We report such a case. A 33-year-old man suffered from transient left motor weakness and visual disturbance. Plain computed tomography (CT) showed a low density area in the left parietooccipital cortex. Enhanced CT revealed a ribbon-shaped enhanced area in the right temporooccipital cortex and a spotty enhanced area in the right frontal subcortex. Cerebral angiography revealed moyamoya disease. On the basis of Suzuki's angiographic classification, the patient was diagnosed as Stage III. Right carotid angiography revealed an arteriovenous malformation fed by basal moyamoya vessels and draining to the vein of Trolard and the sylvian vein of the right frontal lobe. This arteriovenous malformation consisted of feeders, the nidus, and drainers. Trolard's vein, which was one of the draining veins of the arteriovenous malformation, flowed to the moyamoya vessels of the right parietal vault.

Adult↗
PubMed1986

[Treatment of carotid-cavernous sinus fistula by the balloon technique combined with a by-pass procedure using a vein graft-technical note note].

A case with spontaneous carotid-cavernous fistula treated by balloon catheter technique combined with a extra-intracranial by-pass using a saphenous vein graft between the common carotid artery and the middle cerebral artery is reported. A 72-year-old female was admitted with complaints of recurrent symptoms of carotid-cavernous fistula 4 months after spontaneous remission. Angiograms showed the presence left internal carotid-cavernous sinus fistula. Poor cross-filling from the right internal carotid artery to the territory of the left internal carotid artery via the hypoplastic right A1 and left posterior communicating artery was also observed. Symptoms such as chemosis, exophthalmos and visual disturbance gradually progressed during the hospitalization. A common carotid-middle cerebral artery anastomosis was performed with a saphenous vein graft and the carotid cavernous fistula was occluded directly with a balloon catheter. The blood flow via the graft, cortical blood flow, cortical tissue O2 and CO2 were continuously measured during the operation. After the internal carotid artery occlusion, sufficient blood flow via the graft and no significant changes of the cortical blood flow, cortical tissue O2 and CO2 were observed. The postoperative angiogram showed that the by-pass was patent and all branches of the left internal carotid artery were filled via the by-pass. The postoperative course was uneventful and the progressive symptoms improved except for visual disturbance on the left. She is in good condition one year after the operation. The usefulness of this surgical procedure with monitoring of cerebral blood flow and metabolism during operation is also discussed.

Aged↗
PubMed1986

[A case of aneurysm at the junction of the vertebral artery and a spinal arterial branch].

A 68-year-old male suffered from severe occipitalgia, nausea, and vomiting was admitted to our hospital. On admission, he complained only of headache and displayed no evidence of disturbed consciousness or neurological deficits. A computed tomographic (CT) scan revealed a subarachnoid hemorrhage in the basal subarachnoid cisterns, with the thickest, densest area in the bilateral ambient cisterns. Four-vessel angiograms disclosed no pathological findings. The patient was treated with bed rest and his blood pressure was maintained below 120 mmHg. Fortunately, no untoward events occurred during the period of bed rest, and a second vertebral angiogram was obtained 4 weeks after admission. At that time a vertebral artery aneurysm was discovered. At surgery a 3 X 3 X 3 mm aneurysm was found at the junction of the vertebral artery and a branch of the spinal artery. Small clots surrounding the aneurysm were removed. The aneurysm itself was easily clipped without destruction of the caudal cranial nerves and the patient recovered fully. The incidence of vertebral artery aneurysms is very small--about 5%. Moreover, to our knowledge an aneurysm on the proximal portion of the intracranial vertebral artery at the junction of the posterior-inferior cerebellar artery has never before been reported. On the other hand, our case might have been included among cases of subarachnoid hemorrhage of unknown etiology. The first cerebral angiogram revealed no aneurysm; it was found on the second set of angiograms. This case illustrates the importance of repeat angiography when the CT scan clearly shows a subarachnoid hemorrhage.

Aged↗
PubMed1986

[A case of multiple myeloma showing intracranial hypertension due to large cranial mass lesions].

It is well known that the case of multiple myeloma shows punched-out lesions of the cranium without intracranial hypertension. In this paper a case of multiple myeloma is reported showing intracranial hypertension due to a large tumor that developed in the left parietal bone. There are only 13 case reports about cranial mass lesion of multiple myeloma since 1928. A 52 year-old female was admitted to Iwate Prefectural Isawa Hospital suffering from headache, nausea and vomiting. She had been already diagnosed as multiple myeloma and treated with chemotherapy using Cyclophosphamide, Melphalan and Prednisolone for 2 years. On admission, a large subcutaneous mass was presented on the left parietal region. Craniogram revealed large osteolytic lesion of the left parietal bone and 3 punched-out lesions of the frontal bone. CT scan revealed a large mass lesion in the left epidural space, diploe and subcutaneous space. Angiography showed avascular area. Brain scintigram showed diffuse hot area. Other skeletal bones showed no abnormality. Laboratory examination revealed high concentration of gamma-globulin and high erythrocyte sedimentation rate. Electrophoresis showed high value of immunoglobulin G; immunoglobulin assay was as follows: IgG-6000 mg/dl, IgA-150 mg/dl, IgM-410 mg/dl, IgE-0 mg/dl. Serum electrolytes were within normal limits. Urine didn't include Bence-Jones protein. The patient was diagnosed as multiple myeloma suffering from intracranial hypertension caused by large tumor which developed in the left parietal bone. On the operation, large tumor was existed in the epidural and subcutaneous space invading into the diploe but without infiltration into the dura mater or cerebral cortex.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1986

[A case of agenesis of the corpus callosum accompanied by a ruptured azygos anterior cerebral artery aneurysm and lipoma--a case report].

A 53-year-old woman suffered from sudden onset of severe headache on February 28 in 1982. She was admitted to our hospital soon after onset. On admission, she had a severe headache and nausea, and her consciousness was drowsy. CT scan showed a marked subarachnoid hemorrhage with intracerebral and intraventricular hematoma, a separation of the lateral ventricles with enlargement of posterior horns, and deformity of anterior horn. By these findings, the patient was diagnosed as an agenesis of the corpus callosum with subarachnoid hemorrhage. Left carotid arteriogram revealed an azygos anterior cerebral artery and an aneurysm at the terminal portion of this artery. Surgery was performed on the 24 th day after subarachnoid hemorrhage. Operative finding revealed a little finger's head-sized tumor was situated over the right frontobasal artery. An azygos anterior cerebral artery aneurysm was clipped and tumor was removed. Pathological diagnosis of the tumor was a lipoma. Namely, she had an agenesis of the corpus callosum, an azygos anterior cerebral artery, an aneurysm and a lipoma. There are some reports in which an agenesis of the corpus callosum is accompanied with a lipoma and an azygos anterior cerebral artery is accompanied with an aneurysm. But a case of agenesis of the corpus callosum with an azygos anterior cerebral artery was rarely reported. So this rare case with these anomalies was reported and pathogenesis about the development of 4 anomalies was also discussed.

Agenesis of Corpus Callosum↗
PubMed1986

[Intracerebral hemorrhage and characteristic angiographic changes associated with methamphetamine--a case report].

A case of intracerebral hemorrhage and characteristic angiographic changes associated with methamphetamine is reported. A 23-year-old woman suddenly complained of headache, nausea, vomiting and gait disturbance several minutes after intravenous injection of 30 mg of methamphetamine. She was admitted with consciousness disturbance, aphasia and right hemiparesis 26 hours after the onset. CT scan revealed subcortical hemorrhage in the left fronto-parietal region. Left carotid angiogram showed irregular segmental arterial narrowing, "beading" of the anterior and middle cerebral arteries. Emergency craniotomy was performed and a left fronto-parietal hematoma was removed totally. Histologically, the surgical specimen showed many vessels in which included thrombi with perivascular hemorrhage. Post-operative course was uneventful. Repeat carotid angiogram 4 months after the operation revealed normal anterior and middle cerebral arteries. We discussed about associations between the abuse of methamphetamine and the occurrence of intracranial hemorrhage and characteristic angiographic changes. As far as we know, there were 23 reports in an extensive review of the literature on intracranial hemorrhage associated with methamphetamine abuse. In the present case "beading" of the intracranial vessels may be related to angiitis induced by methamphetamine. Both the presence of arterial inflammation and increased blood pressure caused by sympathomimetic action of methamphetamine are probably the important factors in the occurrence of intracranial hemorrhage associated with methamphetamine.

Adult↗
PubMed1985

[Chemiluminescence on hypoxic brain--the 2nd report: cerebral protective effect of mannitol, vitamin E and betamethasone].

The effect of vitamin E, betamethasone and mannitol upon a series of pathological free radical reaction within the hypoxic brain tissue was evaluated by chemiluminescence method. The hypoxic brain was induced by arterial hypoxemia (PaO2 17-22 mmHg) with normocapnia (PaCO2 28-38 mm Hg) and normotension (MABP 100-140 mmHg). 4% O2-96% N2 mixed gas was used as the replacement for obtaining lowered PaO2. In the control group high valued chemiluminescence was measured in the hypoxic state and in the early stage of the initial post-hypoxic state. In the groups administered vitamin E, betamethasone, mannitol and combination of them, however, just extra low valued chemiluminescence was detected. Besides to explore the stage on which the drugs act in lipid peroxidation, chemiluminescence spectra was analyzed using the homogenate added the each drug. Intensity peaks of the spectra were around at 480, 520-530, 570, 620-640, 680-700 nm before addition of the drugs. All the intensity peaks diminished after addition of vitamin E and betamethasone, while in case of mannitol, very little decrease of the intensity peaks was revealed. These experimental results indicate as follows. The lowered chemiluminescence value may prove the possibility of vitamin E, betamethasone and mannitol as free radical scavengers or inhibitor of lipid peroxidation. Chemiluminescence spectro-analysis shows that vitamin E and betamethasone act on the break down of lipid hydroperoxide and mannitol act on hydroxy radical in lipid peroxidation.

Animals↗
PubMed1985

[Clinical analysis of vitreous hemorrhage combined with ruptured aneurysm].

Eight cases of vitreous hemorrhage with ruptured intracranial aneurysm (Terson's syndrome) were experienced in our clinic from April, 1978 to April, 1983. They consisted of five males and three famales between 45 and 69 years old. All cases had unconscious attacks and three of them experienced repeated episodes of subarachnoid hemorrhage within 24 hours. CT scan, performed 24 hours within the attack, revealed remarkable high density areas at prepontine and suprasellar cisterns, interhemispheric and sylvian fissures. Ruptured aneurysms, confirmed by cerebral angiography and operative findings, were three anterior communicating artery aneurysms, three internal cerebral artery aneurysms, one middle cerebral artery aneurysm and one anterior cerebral artery aneurysm. We performed radical operation for the ruptured aneurysm, six cases at acute atage, one at 11 days and one at 18 days after the attack. Postoperative courses were all good. Five cases had bilateral vitreous hemorrhages and three had unilateral ones. At first they were treated conservatively. Visual acuity of six cases, 13 eyes improved gradually, but three cases, four eyes did not improve after four or five months after the attack. So we let ophthalmologist to perform vitrectomy, which showed effective results. Vitreous hemorrhage following a ruptured intracranial aneurysm is not a so rare complication than has been assumed and also its prognosis is not so poor. In most cases vitreous hemorrhage following a ruptured intracranial aneurysm should be treated conservatively, but in selected cases effective results would be given by vitrectomy.

Aged↗