Biomedical subjects
Publications and source records attributed to U Tomiyasu.
Amyloidomas of the central nervous system are rare. Two cases involving middle-aged patients with neurological symptoms are presented. Massive focal accumulations of amyloid in the cerebral hemispheres were confirmed pathologically.
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Approximately one year after partial removal of an intramedullary glioblastoma at T12, a patient was admitted to Wadsworth Veterans Administration Hospital with signs and symptoms of an intracranial tumor. We describe the unusual occurrence of intracranial seeding from spinal glioblastoma and review this rare condition and the possible mechanism involved.
Eye movements were studied with electro-oculography in a patient with primary position, large amplitude, upbeat nystagmus. The upbeat nystagmus increased in amplitude on upward gaze, decreased on downward gaze, and was not altered by loss of fixation. The patient could not produce smooth pursuit movements upward or to the left, but had normal saccadic and vestibular induced eye movements in all directions. At necropsy, a low grade glioma was found involving primarily the medulla and caudal pons. The inferior olives and prepositus hypoglossal nuclei were diffusely infiltrated with tumor. These results suggest (1) primary position upbeat nystagmus is due to a defect in the upward smooth pursuit system, (2) the lower brain stem at the level of the inferior olives and nucleus prepositus hypoglossi is important in the mediation of vertical pursuit, and (3) primary position upbeat nystagmus can result from damage to several nuclei and interconnecting pathways in the caudal brain stem and midline cerebellum involved in control of vertical smooth pursuit.
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A patient with glioblastoma multiforme of the brain was treated with both intravenous and oral glycerol as well as intravenous mannitol in an attempt to reduce increased intracranial pressure. After an initial lowering of the cerebrospinal fluid (CSF) pressure to near normal values during continuous glycerol administration, a secondary rise in CSF pressure above the initial level occurred despite a persistent elevation of plasma osmolality (315 mOsm/kg) and glycerol level (30 mmole/l). Similarly, 4 hours after the administration of a single oral dose of glycerol, CSF pressure increased to levels higher (700 mm H2O) than the original baseline (400 mm H2O).
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A case report and five additional cases from the literature of angiographically demonstrated abnormal vascularization of chromophobe adenomas are presented. The appearance is that of a fine network of vessels appearing in the arterial phase and a homogeneous blush beginning in the capillary phase and lasting throughout the venous phase. The network is derived from dilated branches of the extradural internal carotid artery and is seen in the arterial phase. The stain, appearing in the venous phase, is due to filling of tiny sinusoidal channels and thin-walled vessels throughout the stroma. All the patients had large, actively growing tumours which compressed and infiltrated surrounding structures. Complete tumour removal was not possible in the patients operated upon. The combined morbidity-mortality rate was 83% and was due to the large tumour size, adherence to vital centres, extreme vascularity during surgical removal, and propensity to bleed spontaneously. The appearance of abnormal vascularity in a pituitary adenoma suggests a poor prognosis.