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Biomedical subjects

T Okudera

Publications and source records attributed to T Okudera.

At least 91 records · Page 5Linked to original sources

[Two adult cases of moyamoya disease with intraventricular hemorrhage--angiographic evaluation of periventricular vascular anatomy].

In order to show the vascular anatomy in periventricular region, two adult cases of moyamoya disease with intracerebral hemorrhage extending into lateral ventricle were presented. And we discussed the relation between the vascular anatomy and the form of hemorrhage in moyamoya disease. The first case was a 46-year-old woman admitted for nausea and vomiting following headache for four days. CT scan revealed a high density area in the upper portion of body of right lateral ventricle showing intracerebral hemorrhage which extended into the lateral ventricle. On angiogram, typical moyamoya disease was noted. The ventriculofugal arteries from the posterior lateral choroidal artery was detected which indicated developed ventriculofugal perfusion. The second case was a 52-year-old man who was hospitalized sudden onset of headache, vomiting and consciousness disturbance. CT scan revealed a high density area suggesting of hemorrhage in the head of right caudate nucleus. It perforated into the right anterior horn of lateral ventricle with spreading over the other ventricles. We observed similar findings on the angiograms to the first case. In this case, however, the lateral striate arteries were involved instead of the posterior lateral choroidal artery. It should be pointed out that, in both cases, the area of hemorrhage in CT scan coincided with the area of developed ventriculofugal perfusion in angiograms.

Arterial Occlusive Diseases↗

[A successful transcatheter embolization with occluding spring emboli for vertebral arteriovenous fistulas following insertion of Swan-Ganz catheter].

Vertebral arteriovenous fistulas caused by insertion of percutaneous monitoring catheter through internal jugular vein are rare complications. This is a case report of a successful treatment by transcatheter embolization using spring occluder for the fistulas. Particular attention should be paid to the following: Normal basilar and contralateral vertebral arteriograms are prerequisites to this procedure in order to avoid its potential neurological hazards. For the complete elimination of the fistulas with retrograde filling, embolic material should be placed in the artery not only proximal but also distal to the fistulas opening.

Arteriovenous Fistula↗

Dorsal cyst malformations. Part II. Galenic dysgenesis and its embryological considerations.

In the preceding part, galenic dysgenesis was stated to be a diagnostic hallmark of dorsal cyst malformations. Failed formation of the galenic drainage system conducts the diencephalic drainage laterally into the transverse sinuses as in the embryonal stage, and it is frequently associated with arrested descent of the torcular portion or other anomalies of the dural sinuses. Highly malformed structures of the deep cerebral veins and the dural sinuses seen in this malformation are correctly interpreted in comparison with findings of venous injection studies performed in human fetuses. Pathogenesis of this malformation is also discussed on the basis of embryological studies of the dural sinuses and falcotentorial structures.

Brain↗

Intracranial venous angiomas.

Publications in the scientific literature are controversial in regard to the clinical significance of intracerebral venous angiomas. The present study of 11 patients with venous angiomas underscores the clinical importance of these lesions as potential causes of cerebral hemorrhage and obstructive hydrocephalus. The clinical and radiographic manifestations in 9 of these 11 patients correlated well. In cases of venous angiomas, the venous phase of angiography must be carefully scrutinized, particularly in patients with subarachnoid or intracerebral hemorrhage. Some diagnostic problems related to the angiography of venous angiomas are discussed.

Adolescent↗

Basilar artery occlusion in a case of Duchenne muscular dystrophy.

This is a report of a case of Duchenne muscular dystrophy (DMD), with multiple infarcts in the territories of the basilar artery. He developed abrupt vomiting and transient left hemiparesis at the age of 4 years. The episodes were seen 3 times between 4-year-1-month to 5-year-1-month old. Transaxial computerized tomography (CT) revealed multiple, well-defined but irregularly marginated areas of low density centered in the mid- and upper pons, right cerebral peduncle and thalamus. A right vertebral angiogram illustrated the narrowed basilar artery. The rectus femoris muscle was biopsied at the age of 4-year-1-month which showed marked variation in fiber size, myonecrosis with phagocytosis, central nuclei, and adipose and connective tissue proliferation, which were consistent with those seen in DMD. It remains unknown whether the basilar artery occlusion was an incidental event in this particular case or closely related to the disease process of DMD.

Biopsy↗

Structures and development of the venous system in congenital malformations of the brain.

Cerebral venograms of 21 clinical cases of midline anomalies of the brain and of 80 human fetuses between 3 and 8 months old were examined. The diagnostic value of the venogram was fully proven, particularly for the midline cerebral anomalies, where deep cerebral structures and configuration of the tentorium cerebelli were not well visualized by other neuroradiologic maneuvers. Abnormal structures of the deep cerebral veins as well as the dural sinuses in these malformations were proved to retain the venous structures in the early fetal period. The time of formation of these malformations was also inferred from the viewpoint of the venous development. Study of the fetal venous system was found quite useful for embryologic analysis and classification of congenital malformations of the brain.

Brain↗

Angiographic diagnosis of fourth ventricle tumors.

Twelve primary fourth ventricle tumors and 22 medulloblastomas occupying mainly the fourth ventricle were analyzed, with emphasis on the differential diagnosis, vascularity, and some unusual findings. Though both types of tumor often have identical manifestations, the correct diagnosis can be made in most cases by careful evaluation of the posterior inferior cerebellar artery, particularly the choroidal and nodular branches. Unusual findings in primary fourth ventricle tumors mimicking tumors of the pons and medulla oblongata are described, and possible explanations for these findings are discussed. The results of this study underscore the importance of angiotomography in the diagnosis of tumors of the fourth ventricle.

Adult↗

[Angiographic diagnosis of non-neoplastic aqueductal stenosis in children (author's transl)].

Angiograpic diagnosis of non-neoplastic aqueductal stenosis in 4 children were described. The materials were selected from 160 vertebral angiograms of children below 15 years, performed at the Kyushu University Hospital from July 1967 to March 1974. There were 4 cases of angiographically demonstrated non-neoplastic aqueductal stenosis. These cases were confirmed by pneumoence-phalogram and/or pneumoventriculograms, which were performed before and after the Tolkildens procedure. Ages of the patients varied from 6 to 15 years with average of 11.8 years. All the angiographic findings of these 4 patients with non-neoplastic aqueductal stenosis were explained on the basis of 5 major morphological changes such as 1) marked symmetrical obstructive hydrocephalus, 2) dilatation of the third ventricle and aqueduct above the obstruction with resultant downward displacement and compression up the upper brain stem and posterior displacement of the precentral cerebellar fissure, 3) maintenance of normal shape and position of the lower half of the posterior fossa structure, 4) absence of midline shaft of the median and paramedian vessels, 5) morphologic changes of the subarachonoid cisterns. These angiographic findings coincided with the angiographic features as described by Huang et al. (1968), under the experience with 10 cases of non-neoplastic aqueductal stenosis of adults, averaging of 43 years. Special emphasis was placed on the diagnostic value of the small veins and arteries in the posterior fossa vascular system. We also emphasized that the vertebral angiography should be performed as the first investigative procedure using the contrast media in the posterior fossa lesions.

Adolescent↗

[Neuroradiologic diagnosis of trigeminal neurinoma originating from the gasserian ganglion (author's transl)].

Three cases of trigeminal neurinoma originating from the Gasserian ganglion were reported. The findings observed on plain roentgenograms, cerebral angiograms and pneumoencephalograms were described in detail. Neuroradiologic examinations used routinely our department for the diagnosis of the skull base tumors were as follows; (1) plain skull examinations, including lateral, straight posterior-anterior, anterior-posterior half axial (Towne), axial, Stenvers, optic canal as well as tomograms in frontal, sagittal and axial projections; (2) angiographies by transfemoral catheter technique including selective internal carotid, external carotid and vertebral angiograms, and orbital-cavernous sinus venography via frontal and femoral veins; (3) pneumoencephalography with tomography. Bone destruction of the middle fossa including foramen ovale, foraman spinosum and lateral aspect of the sella was seen in all cases. Superior orbital fissure, optic canal and anterior surface of the petrous bone were also eroded depending upon the extent of tumors. Sharply circumscribed erosion of the petrous apex was seen in one of 3 cases, indicating the tumor extention into the posterior fossa. A soft tissue mass in the sphenoid sinus and ethmoidal air cells was recognized in all cases. Selective internal and external carotid angiograms demonstrated tumor vessels in 2 of 3 cases. Orbital-cavernous sinus venography was helpful for the interpretation of the lesion extending to the cavernous sinus and its neighboring structures. Conventional gas encephalography showed elevation of the temporal horn, and the concave arch formed by the supracornual cleft and lateral cleft was directed basally and medially in all of the cases. Tomography was also useful in the more detailed analysis of temporal horn. It should be stressed that the plain skull features are most important for deciding which contrast examination should be performed further.

Adult↗