Reentrant spin-glass transition in a dilute magnet

We perform a large-scale Monte Carlo simulation of a dilute classical Heisenberg model with ferromagnetic nearest neighbor and antiferromagnetic next-nearest neighbor interactions. We found that the model reproduces a reentrant spin-glass transition. That is, as the temperature is decreased, the magnetization increases rapidly below a certain temperature, reaches a maximum value, and then disappears at some lower temperature. The low temperature phase was suggested to be a spin-glass phase that is characterized by ferromagnetic clusters.

Injury and repair of the soleus muscle after electrical stimulation of the sciatic nerve in the rat

To study injury and subsequent changes in skeletal muscles, the rat sciatic nerve was electrically stimulated at 50 Hz and muscle contraction was induced for 30 min. Muscle damage was classified into five types (hypercontraction, hyperstretching, Z band disorders, misalignment of myofilament and regions of scarce myofilaments) by electron microscopy and quantified by ultrastructural assessment. After electrical nerve stimulation, the percentages of the injured areas of the soleus muscle were 18.8 +/- 15.8% (mean +/- SD) at 0 h, 9.7 +/- 1.0% at 6 h, 22.0 +/- 23.6% at 12 h, 13.1 +/- 3.2% at 24 h, 4.9 +/- 6.0% at 3 days and 0.5 +/- 0.4% at 7 days. At 0 h, the vast majority of ultrastructural alterations were sarcomere hypercontraction. At 6 h, hypercontraction was not recognizable and sarcomere hyperstretching and Z band disarrangement constituted the major findings. At 12 h, when the injury reached its maximum, myofilament disorganization and hyperstretching were predominant. At 24 h or afterwards, the injury began to decrease and recovered to almost normal conditions by 7 days. There were very few necrotic muscle fibers in all specimens. It is considered that the muscle lesions in the present study were reversible, and recovered through changes in various types of sarcomere alterations. Z band streaming and free ribosomes were frequently found at 12 and 24 h, which may indicate repair processes rather than newly formed lesions.

Surgical strategy for cavernous angioma in hypothalamus

A very rare case of cavernous angioma in the hypothalamus is presented. The patient was successfully treated by total excision of the haematoma and angioma, and there was no regrowth of the lesion on follow-up MRI. Complete excision of the angioma is the recommended surgical strategy even for patients with deep-seated lesions.

Microvascular decompression for cochlear symptoms

OBJECT

The object of this study was to evaluate the efficacy of a new neurovascular decompression technique in relieving symptoms of cochlear nerve dysfunction.

METHODS

Nineteen patients with slowly progressive hearing loss, low-frequency fluctuating hearing loss, and high-pitched tinnitus due to neurovascular compression (NVC) of the eighth cranial nerve in a triangular space between the seventh and eighth cranial nerves (the VII-VIII triangle) of the cerebellopontine angle (CPA) were treated using a new technique for microvascular decompression that was developed by anatomical study in 24 cadaver specimens of the CPA. In 12 of 19 patients the anterior inferior cerebellar artery (AICA) was observed to cause compression in the VII-VIII triangle and this vessel was easily mobilized medially for placement of a silicone sponge or Teflon cushion between the compressing artery and nerve. Postoperatively, hearing loss of 20 dB or more that was present in 11 of the 19 patients with NVC improved by more than 5 dB in seven (64%), including the patient with the most severe hearing loss. Of 18 patients presenting with tinnitus preoperatively, eight (44%) had no tinnitus and an additional nine (for a total of 94%) had good improvement in tinnitus after surgery and at long-term follow up.

CONCLUSIONS

The microvascular decompression technique described is highly successful in treating symptoms due to direct or indirect compression of the cochlear nerve, with minimal risk of complications. Recordings of auditory brainstem responses confirmed the clinical diagnosis of NVC of the eighth cranial nerve and correlated with clinical results after microvascular decompression of the cochlear nerve.

Time-resolved electron spin resonance of gallium and germanium porphyrins in the excited triplet state

Gallium and germanium porphyrin complexes in the lowest excited triplet (T1) state have been studied by time-resolved electron spin resonance (TRESR). It is found that for Ge(TPP)(OH)2 (TPP = dianion of tetraphenylporphyrin) intersystem crossing (ISC) from the lowest excited singlet (S1) state to the T1x and T1y sublevels is faster than that to the T1z sublevel (T1x, T1y, and T1z are sublevels of the T1 state), while the ISC of ZnTPP and Ga(TPP)(OH) is selective to the T1z sublevel. This is interpreted by a weak interaction between the dpi orbital of germanium and LUMO (eg) of the porphyrin ligand, resulting in small spin-orbit coupling (SOC). The interpretation is supported by molecular orbital calculations. The ISC of Ge(OEP)(OH)2 (OEP = dianion of octaethylporphyrin) and Ge(Pc)(OH)2 (Pc = dianion of tetra-tert-butylphthalocyanine) is found to be selective to the T1z sublevel in contrast to Ge(TPP)(OH)2. This dependence on the porphyrin ligand is reasonably explained by a difference between the 3(a(1u)eg) (the OEP and Pc complexes) and 3(a(2u)eg) (the TPP complex) configurations. This is the first observation of a difference in selective ISC between the 3(a(1u)eg) and 3(a(2u)eg) configurations. The TRESR spectrum of Ge(TPP)Br2 is different from those of Ge(TPP)Cl2 and Ge(TPP)(OH)2, and is interpreted by SOC between the T1 and T2 states. From ESR parameters the square of the coefficient of the eg orbital on bromine is evaluated as 0.018 in the T1 state.

[Diagnosis and treatment of nontraumatic dissecting aneurysm in the middle cerebral artery]

Two cases of nontraumatic dissecting aneurysm of the middle cerebral artery (MCA) are reported. A 59-year-old woman presented with subarachnoid hemorrhage, mainly in the right sylvian fissure. On admission, the right carotid angiogram revealed a dissecting aneurysm with a double lumen extending from segment M1 to M2 of the right MCA, and an unruptured saccular aneurysm in the right internal carotid artery. Emergency surgery revealed a discolored protrusion of the arterial wall in the right MCA, which was thought to be the cause of her subarachnoid hemorrhage. The protrusion of the arterial wall was clipped and coated with Bemsheet soaked in Biobond. However, disturbance of consciousness persisted and she died of paralytic ileus two months after the operation. The other patient was a hypertensive 33-year-old woman with right hemiparesis and motor dysphasia. CT scans obtained on the day of admission showed no abnormalities. She was treated conservatively with clinical improvement, but CT scans obtained 3 days after the ictus revealed an infarction deep in the left frontal lobe. A left carotid angiogram was made 4 days after ictus and demonstrated severe stenosis of the proximal segment of the left MCA with poor filling of its superior trunk. Despite improvement of her hemiparesis, CT scans obtained 3 weeks after the ictus showed hemorrhagic infarction in the left frontal lobe. Repeat left carotid angiogram revealed a double lumen in the C1 and M1 portions with improvement of the previous severe stenosis of the M1. The 23 reported cases of DA in the MCA with our cases are reviewed and their neuroradiological and clinical features are discussed.

Vertebral artery dissection not detected by initial angiography--case report

A 57-year-old male presented with subarachnoid hemorrhage caused by vertebral artery dissection. The first cerebral angiogram on the day of ictus found minimal caliber change with lower contrast density at the V4 segment, but repeat angiography showed typical segmental narrowing of the artery on the 14th day. Repeat angiography with magnetic resonance imaging in the subacute stage would be useful to identify the cause of "angiogram-negative" subarachnoid hemorrhage.

Sphenoethmoidal mucoceles with intracranial extension--three case reports

Three unusual cases of sphenoethmoidal mucoceles with rare intracranial extension are reported. A 64-year-old female presented with a 7-month history of right visual disturbance. Computed tomography (CT) and magnetic resonance (MR) imaging demonstrated a huge mass in the right middle fossa. She underwent right frontotemporal craniotomy. Postoperatively, her proptosis and cranial nerve dysfunction had improved markedly. A 53-year-old female complained of headache, nausea, and dizziness. CT and MR imaging revealed a cystic mass filling the right sphenoid sinus. The cystic lesion was evacuated through the transnasal approach. She was doing well postoperatively and has been asymptomatic. A 39-year-old male complained of headache, vomiting, and right visual disturbance. CT and MR imaging demonstrated a homogeneous mass occupying the sphenoid sinus. Sphenoidotomy exposed the cyst extending superiorly into the anterior cranial fossa. He recovered from the visual disturbances and has been asymptomatic since. MR imaging provides confirmation of the diagnosis of sphenoethmoidal mucocele and is important for preoperative evaluation.

Surgical modulation of the natural course of collateral circulation in chronic ischemic patients

The purpose of this study was to evaluate hemodynamic compromise in terms of baseline CBF and CRC in patients with chronic cerebral occlusive lesions and its modulation by a superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis. The study subjects were 10 healthy volunteers and 49 chronic ischemic patients with stenosis or occlusion of the internal carotid artery (ICA) or middle cerebral artery (MCA). The hemodynamics were measured using stable xenon enhanced computed tomographic CBF measurement with the acetazolamide challenge. The compromised hemodynamics in patients with chronic steno-occlusive lesions did not improve during their natural course after two months. STA-MCA bypass modulated hemodynamic compromise in the ischemic patients. We recommend STA-MCA bypass for patients with reduced CRC, regardless of whether baseline CBF is reduced or normal. Hemodynamic classification using a combination of baseline CBF values and CRC values is useful for evaluating cerebral hemodynamics and for choosing the best treatment for cerebral ischemia with occlusive lesions.

Pulmonary embolism after cerebral angiography--three case reports

Three patients developed acute pulmonary embolism after cerebral angiography. The diagnoses were based on the clinical symptoms and echocardiography, chest roentgenography, blood gas analysis, and pulmonary perfusion scans after intravenous injection of 5 mCi of technetium-99m-labeled human albumin macroaggregates. Two of the three patients achieved clinical improvement, but one patient with severe embolization and circulatory deterioration died in spite of anticoagulation therapy. Recognition of the potential risk of pulmonary embolism after angiography and active prophylaxis are most important in preventing this complication.

Noninvasive detection of intracranial vascular lesions by recording blood flow sounds

BACKGROUND AND PURPOSE

Transorbital blood flow sound recordings have the potential to be used for noninvasive detection of cerebral aneurysms and arteriovenous malformations. We describe our system and experience in detecting intracranial cerebrovascular disease.

METHODS

We investigated the noninvasive detection of intracranial vascular lesions by recording and analyzing the intracranial blood flow sounds. A new small transducer was placed on the unilateral eyelid to record the intracranial blood flow sounds, which were amplified and converted to digital data at a sampling frequency of 2000 Hz to provide a spectral analysis.

RESULTS

No spectral peaks were recorded in 30 healthy adults. Sharp peaks were recorded in 12 of 15 patients with unclipped aneurysms, and broad peaks were recorded in two patients with vasospasm after aneurysmal clipping and in all patients with severe intracranial internal carotid artery stenosis.

CONCLUSIONS

This noninvasive technique has the potential to be very useful in the detection of intracranial cerebrovascular disease, including aneurysm and arterial stenosis, and could be used in mass screening examinations.

[Radiation-induced cerebrovasculopathy: a case report and review of the literature]

We reported a case of a patient who suffered from a cerebrovasculopathy after irradiation therapy for astrocytoma located at the left temporal lobe. An eleven year-old boy who presented himself with headache and vomiting as his chief complaints received partial removal of a tumor. Histological diagnosis of the tumor was astrocytoma (grade II). His preoperative cerebral angiograms showed mass sign solely, without stenosis or occlusion of the cerebral vessel. Postoperatively, he was treated with irradiation therapy involving the whole brain with a total of 30 Gy, and gamma knife therapy. Six months after irradiation, he started suffering from frequent cerebral ischemic attacks, but there was no regrowth of the tumor visible on CT scans. Cerebral angiograms were made again, and revealed multifocal stenoses in the bilateral internal carotid arteries, middle cerebral arteries, and the anterior cerebral artery. His symptoms did not improve after conservative treatment with steroids, calcium antagonist, or low molecular weight dextran. Although he received a superficial temporal artery-middle cerebral artery (STA-MCA) anastomoses bilaterally, multiple cerebral infarctions appeared. Although irradiation therapy is acceptable in patients with brain tumor, a cerebrovasculopathy after irradiation should be considered as one of the most important complications, and the risk incurred by irradiation therapy should lead to more careful consideration and caution when treating intracranial brain tumors, especially in children. From our experience, the usefulness of bypass surgery for radiation-induced cerebrovasculopathy is still controversial.

[A case of cough headache with Chiari malformation (type I)]

A 38-year-old woman complained for about 5 years of attacks of headache elicited by coughing, sneezing, and laughing. These attacks became more frequent and more severe. Physical examination showed a short and broad neck. Neurological examination revealed no abnormality. Magnetic resonance imaging demonstrated the Chiari malformation (type I) and the cerebral venous angioma in left frontal white matter. A posterior decompression by suboccipital craniectomy with C1 laminectomy was performed. The headache completely disappeared. Before and after the operation, we measured the intracranial subdural pressure by a small pressure transducer. The raised cranial pressure by the Valsalva's maneuver prolonged for more than one minute. Postoperatively, the raised cranial pressure by the Valsalva's maneuver decreased rapidly. We consider that the cough headache of this patient was associated with a valve-like blockage by the Chiari malformation (type I) at the foramen magunum, resulting in cranio-spinal pressure dissociation by interference with downward pulsation. We believe that there was no correlation between the cough headache and the cerebral venous angioma.

Abnormal continuous flow in giant intracranial aneurysm detected by transcranial Doppler sonography--case report

Transcranial Doppler sonography demonstrated a huge, non-thrombosed intracranial aneurysm in a 62-year-old male preoperatively as abnormal continuous flow, which disappeared after aneurysmal neck clipping. Transcranial Doppler sonography is very useful to assess hemodynamics in the parent artery and the dome of the aneurysm.

Direct surgery for giant aneurysm exhibiting progressive enlargement after intraaneurysmal balloon embolization

A case of giant intracranial carotid artery aneurysm exhibiting progressive enlargement after incomplete intraaneurysmal balloon embolization is presented. The patient was successfully treated by the trapping and decompression of the aneurysm with a superficial temporal artery-middle cerebral artery anastomosis. The thrombus surrounding the intraluminal balloons was very soft and poorly organized. Either direct surgery with extracranial-intracranial arterial bypass or complete intravascular surgery should be performed for giant aneurysms when direct clipping is impossible.

[A study of ionized calcium in the whole blood of patients with subarachnoid hemorrhage]

In 14 normal volunteers and 22 consecutive patients with subarachnoid hemorrhage (SAH) due to a ruptured cerebral aneurysm, ionized calcium (Ca2+) concentrations in whole blood were measured using an automatic calcium analyzer. The values were corrected against pH 7.4. The relationships between the Ca2+ concentration and the following aspects were studied: neurological grading by Hunt and Kosnik, grade of SAH on computed tomography scan by Fisher's definition, and the presence of vasospasm. Clinical vasospasm was recognized in eight cases. The averaged Ca2+ value of the control group was 1.23 +/- 0.02 mmol/l. In patients with a poor neurological grade or severe SAH, the Ca2+ level was apt to be lower than that of the control group. In patients with vasospasm, the values of Ca2+ were significantly decreased, especially between 8 and 14 days after SAH, compared with those patients without vasospasm and the control group (p less than 0.05). These results indicate that measurement of Ca2+ concentration in whole blood may give a useful clue to treatment of vasospasm by calcium antagonist and that it may also provide a possible indicator as to the time of vasospasm in patients with severe SAH. However, it is very difficult to conclude whether decreased level of Ca2+ in patients with vasospasm is caused by the vasospasm itself.

True posterior communicating artery aneurysm

Two rare cases of true posterior communicating artery aneurysm are reported. One case was a saccular aneurysm, which was successfully clipped. The other was a case of fusiform trapped aneurysm, and hemiparesis and oculomotor palsy appeared transiently after surgery. In general, this type of aneurysm is included in the category of internal carotid-posterior communicating aneurysm, although some special considerations are necessary in surgical treatment.

Changes in brain stem blood flow under various grades of brain stem ischemia

This report describes a study of brain stem blood flow (BBF) change under various grades of brain stem ischemia in a new experimental rat model. The main damage was caused by occlusion of the median and paramedian perforating arteries of the basilar artery. In this model, hyperperfusion was generally observed in cases of mild or moderate ischemia within 1 hr after recirculation and lasted for approximately 1 hr. During hyperperfusion, BBF increased to over 60 ml/100 g brain/min and was significantly greater than basal values (p less than 0.01). The fact that hyperperfusion was unobserved in some cases might be due to the degree of damage to the medulla oblongata. Hypoperfusion or lack of reflow phenomena was also followed by severe ischemia with remarkable hypotension. It is fairly clear from our results that the pattern of postischemic hyperperfusion is responsible for decreased oxygen availability in the brain stem and dysfunction of autoregulation. Acetazolamide reactivity was disturbed and had an inverse response during hyperperfusion. Such phenomena can be explained by paralytically dilated vessels due to ischemia. If BBF falls below a critical level, as we have seen, postischemic hyperperfusion may be induced with dysfunction of autoregulation and inverse acetazolamide reactivity due to vasoparalysis in the brain stem.

[An examination of change in blood flow in the brainstem of rats under various grades of ischemia]

A study was made of changes in brainstem blood flow (BBF) under various grades of ischemia in a rat recirculation model.

MATERIALS AND METHODS

Adult male Wistar rats were anesthetized with pentobarbital sodium (40mg/kg i.p.). After exposure of the cervical vertebra (C2 portion), embolic threads of various sizes prepared were inserted into the vertebral artery. By the hydrogen clearance technique, changes in BBF were measured in 30 rats before, during and after brainstem ischemia.

RESULTS AND DISCUSSION

The mean arterial blood pressure (MABP) was 113 +/- 5.8mmHg, and the mean BBF was 35.5 +/- 2.4ml/100g/min before ischemia. The alteration of BBF during and after ischemia was classified into three groups. The mildly ischemic group showed no significant changes in MABP; BBF was above 15ml/100g/min during ischemia, with slight reactivity revealed by acetazolamide after recirculation. In the moderately ischemic group, MABP dropped significantly to 62.0 +/- 12.4mmHg. After recirculation, it increased gradually to almost the control level. BBF decreased to below 15ml/100g/min immediately after ischemia, followed by a gradual increase to hyperperfusion after recirculation. After 1hr of recirculation, BBF increased to more than 60ml/100g/min with inverse acetazolamide reactivity. In the severely ischemic group, both BBF and MABP decreased irreversibly even after recirculation. These data indicate that the changes in MABP and BBF could be classified according to the degree of ischemic damage in the brainstem, where the vasomotor center is located. Acetazolamide reactivity was disturbed during hyperperfusion. Such phenomena could be explained by the presence of paralytically dilated vessels. If BBF falls below the critical level, as we showed here, it may induce postischemic hyperperfusion associated with dysfunction of autoregulation and vasoparalysis in the brainstem.

The effect of EC-IC bypass surgery on resting cerebral blood flow and cerebrovascular reserve capacity studied with stable XE-CT and acetazolamide test

Cerebral blood flow (CBF) and cerebrovascular reserve capacity (CRC) were measured by stable xenon computerized tomography (Xe-CT) and acetazolamide test in 15 patients with cerebrovascular disease before and after extracranial-intracranial (EC-IC) bypass surgery for minor stroke, reversible ischemic neurological deficit or transient ischemic attack. All had angiographically shown occlusive lesions of the major arterial trunk. In the present series, global analysis showed that the bypass did not increase the resting rCBF, but did increase the rCRC. We divided the patients into four groups according to the preoperative resting rCBF and rCRC. All 3 patients with normal resting rCBF and reduced rCRC showed postoperative improvement of rCRC. Of 6 patients with reduced CBF and reduced CRC, three had postoperative increase in resting CBF and four had increased CRC. One of two patients with reduced CBF and normal CRC showed only an increase in CRC. We propose that reduced CRC or reduced CBF with reduced CRC are criteria for selection of candidates for bypass surgery. We conclude that Xe-CT with the Diamox test is a useful and simple method for evaluating cerebral hemodynamics. Preoperative grouping with a combination of preoperative resting rCBF and preoperative rCRC is useful for predicting the effect of EC-IC bypass surgery.

[Ischemic cerebrovascular complication in tuberculous meningitis; a case of Fröhlich syndrome and hemiparesis]

A 34-year-old man came to our hospital with an episode of focal convulsion of the left arm. He had suffered from tuberculous meningitis in childhood and developed left hemiparesis and Fröhlich syndrome as sequelae. CT scan showed a calcified mass in the suprasellar cistern and a low density area suggestive of cerebral infarction in the right anterior cerebral artery distribution. The left carotid angiograms showed severe stenosis of the left internal carotid artery in the supra-clinoid segment and occlusion of the proximal middle and anterior cerebral arteries with development of moyamoya vessels as collateral circulation. The right carotid angiograms showed similar findings with less collateral circulation. At surgery, the anterior part of the Willis ring was found embedded in the suprasellar calcified granuloma. Recognition of cerebrovascular complication in tuberculous meningitis is important and an early modification of the therapy may improve the outcome.

[Anastomosis of the superficial temporal artery to the middle cerebral artery for occlusive disease of the bilateral internal carotid arteries with dementia]

Two cases are reported of occlusive disease of the bilateral internal carotid arteries with dementia in which the anastomosis of the superficial temporal artery to the middle cerebral artery (STA-MCA bypass) resulted in marked improvement in clinical aspects. One patient was a 29-year-old male who complained of transient weakness of the extremities and memory impairment. Computerized tomography (CT) scans showed multiple small infarctions, while cerebral angiography demonstrated findings of Moya-like disease. The cognitive function tests were subnormal and the study of cerebral blood flow (CBF study) showed diffuse low flow in both hemispheres. Based on his clinical symptoms and CBF study, the STA-MCA bypass was performed on both sides in two stages without complications. Postoperatively, his clinical symptoms and cognitive function improved gradually, in accordance with increased CBF in both hemispheres. Six months after the operation, cognitive function tests were within normal limits. Another patient was a 61-year-old hypertensive male who complained of motor weakness, impairment of memory and urinary incontinence. CT scans showed multiple small infarctions, while cerebral angiography revealed occlusion of both internal carotid arteries at the cervical portion. The cognitive function was at the pre-dementia level, and CBF study revealed diffuse low flow in both hemispheres. Based on the clinical symptoms and CBF study, the STA-MCA bypass was performed on both sides in two stages. Postoperatively, clinical symptoms and cognitive function markedly improved. From our results, the diagnosis of vascular dementia, and indications for the use of STA-MCA bypass in this category of patients are discussed.

Subependymal giant cell astrocytoma associated with tuberous sclerosis: with special reference to cell kinetic studies--case report

The authors report a case of subependymal giant cell astrocytoma associated with tuberous sclerosis in a 15-year-old boy. Computed tomographic scans showed a large intraventricular mass with peritumoral calcification and a cyst in the left lateral ventricle. Left dominant unilateral hydrocephalus was also revealed. Magnetic resonance images clearly demonstrated the lesion. The tumor was subtotally removed and a ventriculoperitoneal shunt was performed because of the hydrocephalus. The proliferation potential was assessed by measuring the bromodeoxyuridine (BUdR) labeling index employing the in vitro labeling method, and determining the deoxyribonucleic acid (DNA) content by flowcytometry. BUdR-positive cells were found to be rare, and the DNA histogram demonstrated no evidence of high proliferative activity or aneuploidy.

Interposition of a saphenous vein graft for early recurrent carotid stenosis--report of two cases

The main cause of recurrent stenosis within 24 months of carotid endarterectomy is myointimal hyperplasia. In these cases, reoperation is technically difficult because there is no true plane of dissection between the recurrent plaque and the remaining vessel wall. The authors present two cases of early recurrent stenosis after carotid endarterectomy, both of which were successfully treated by an interposed saphenous vein graft. In the first case, angiography suggested that the recurrent stenosis was due to atherosclerosis. In the second case, however, myointimal hyperplasia was suspected to be the cause, and this was confirmed by histological examination of the surgical specimen. The authors' experience indicates that anastomosis with an interposed saphenous vein graft is a reliably effective treatment for early recurrent carotid stenosis.

[Coagulation and fibrinolysis in chronic subdural hematoma. Measurement of fibrinopeptides]

The pathogenesis of chronic subdural hematoma is not fully understood. It is thought that fibrinolytic hyperactivity within the hematoma capsule plays an important role. However, since this hyperactivity has not been found in the systemic blood, accelerated fibrinolysis is thought to occur only locally. To evaluate coagulant and fibrinolytic activities in the peripheral blood, the authors measured fibrinopeptide A (FPA) and fibrinopeptide B beta 15-42 (FPB beta), which are relatively sensitive hematologic factors, in 14 patients with chronic subdural hematoma. Peripheral venous blood was collected within 24 hours before surgery and FPA and FPB beta levels were determined. In the eight cases followed for more than 1 month after surgery, pre- and postoperative FPA and FPB beta values were compared. The possible relationship between preoperative FPB beta and hematoma density as well as elevated intracranial pressure (judged by preoperative computed tomography) was also examined. The following results were obtained: 1) Preoperative FPA and FPB beta values were both statistically significantly elevated suggesting systemic acceleration of coagulant and fibrinolytic activities. FPB beta levels exceeded those of FPA in almost all cases, indicating that fibrinolysis was more dramatically enhanced. 2) Many patients with high FPB beta values had high-density areas on computed tomography scans. 3) Patients with choked disc had high FPB beta values, suggesting a correlation between chronic intracranial hypertension and FPB beta. 4) Postoperatively, there was a marked decrease in FPA values, whereas FPB beta values remained above normal, which may reflect persistence of accelerated systemic fibrinolytic activity in patients with chronic subdural hematoma.

Improved separation of alpha chains of collagen type I, type III, and type V by noninterrupted electrophoresis using thioglycolic acid as a negatively charged reducer

Improved separation of alpha chains of collagen type I (alpha 1 [I]2 alpha 2[I]), type III(alpha 1[III]3), and type V (alpha 1[V]alpha 3[V])was achieved by noninterrupted sodium dodecyl sulfate-polyacrylamide gel electrophoresis with a negatively charged reducer, thioglycolic acid. The thioglycolic acid, added to the running buffer of the cathodic reservoir, in the middle of electrophoresis quickly migrated in the gel anode, reducing interchain disulfide linkages in collagen type III and dissociating it into its alpha chain monomer, alpha 1[III], without an interruption of electrophoresis. The alpha chain, alpha 1[III], migrated more slowly than the alpha 1 [I] and alpha 2[I] chains of collagen type I, resulting in an excellent separation of alpha 1[III] from alpha 1[I]. The mobility of alpha 1[III] could be controlled by varying the time of thioglycolic acid addition to the running buffer. This enabled us not only to separate alpha 1[III] from alpha 1[I] and alpha 1[V], but also to precisely quantitate these alpha chains, even at low protein loading of mixed samples.

Infrasellar craniopharyngioma

A rare case of infrasellar craniopharyngioma mainly occupying the paranasal sinuses, the infratemporal fossa and the skull base is presented. The patient had been treated by an otolaryngologist as a case of mucocele of the sphenoid and ethmoid sinuses because the biopsy specimens obtained at endonasal surgery failed to confirm the true diagnosis. Computed tomography (CT) showed multi-lobulated low density cysts in the paranasal sinuses, infratemporal fossa and skull base, and the cyst wall was enhanced. Magnetic resonance Imaging (MRI) revealed the cysts to have high intensity in both T1- and T2-weighted images, and excellent three-dimensional visualization was obtained. Characteristic motor-oil-like fluid was aspirated during transnasal surgery and the diagnosis of craniopharyngioma was confirmed by histological examination.

[A case of hemorrhage into a brain abscess]

A rare case of hemorrhage into a brain abscess in a 23-year-old man is reported. The patient complained of headache and low-grade fever on February 26, 1986. Two days later, he developed right hemiparesis and right hemisensory disturbance with mild consciousness disturbance and was admitted to a local hospital. Seven days after the onset, he suddenly became semicomatose, developed anisocoria and was consequently transferred to the University Hospital. On admission, his temperature was 37.5 degrees C and neurological examination revealed semicoma, anisocoria and right hemiparesis without nuchal rigidity. Enhanced CT scan showed a high density area within an irregular ring enhancement at the left basal ganglia. At that time, malignant glioma was diagnosed and an emergency operation was performed by left frontotemporal craniectomy. During the operation blood clot was found in the posterior part of the basal ganglia. After operation, a histological examination was made and a brain abscess was diagnosed. Gram staining revealed gram-positive bacillus. By aspiration of the abscess and chemotherapy, recovery was gradually made. He was discharged with motor dysphasia and mild right hemiparesis three months later. Differentiation between abscess and malignant glioma and the cause of the hemorrhage are discussed.

Intrasphenoidal encephalocele: report of a case

The diagnosis of intrasphenoidal encephalocele may be difficult because of its rarity and its nonspecific signs and symptoms. The authors report a patient with intrasphenoidal encephalocele who was operated on by the transsphenoidal approach with a good result. They also review five reported cases, with discussion of their clinical characteristics and operative indications.

[Intracranial neurinomas of the jugular foramen and hypoglossal canal]

Intracranial neurinomas of the jugular foramen and the hypoglossal canal are relatively rare. Most reports have been of either single cases or of only two or three patients, and few large series exist in the literature. Although some of these tumors present palsies of the ninth, tenth, and eleventh cranial nerves as a jugular foramen syndrome, this is not always present. Unexpectedly, symptoms involving the eighth nerve are more frequently than those of ninth, tenth and eleventh nerves. This variability of clinical symptoms frequently leads to an initial misdiagnosis of glomus jugulare, acoustic or hypoglossal neurinoma. We report 2 cases of jugular foramen neurinomas and 2 cases of hypoglossal neurinomas. Our review of literature has tabulated 92 jugular foramen neurinomas and 34 hypoglossal neurinomas. These neurinomas had become considerably large in size by the time they were detected. So, we should endeavor, by clinical or neuroradiological finding to detect them at the early stage when they exert less influence on the brain. In this series we discuss clinical pictures of these neurinomas.

Bilateral intracranial fibrous xanthoma

We present a case of fibrous xanthoma in a 6-year-old boy who showed disturbance of consciousness and signs of increased intracranial pressure. A computed tomographic (CT) scan showed bitemporal enhanced masses and hydrocephalus. The patient was operated on in two stages. The tumors were located intradurally and extracerebrally and were firmly attached to the dura mater at the base of the middle fossa. Glial fibrillary acidic protein stain was negative, and histologic examination suggested a diagnosis of bilateral fibrous xanthoma. Postoperative CT scan showed residual tumors and an enlarged choroid plexus adjacent to it. A CT scan at 12 years of age showed no enhanced tumor, but disclosed bitemporal high-density areas and diffuse brain atrophy; the choroid plexus reverted to normal size. The patient showed mental and physical retardation, perhaps owing to the compression of the hypothalamus during early childhood. This would appear to be the first known case of bilateral intracranial fibrous xanthoma.

Brainstem abscess

A case of midbrain abscess that was successfully treated by surgical evacuation is reported. The abscess was located in the rostral tegmentum of the midbrain and was aspirated using an infratentorial supracerebellar approach. The patient subsequently returned to his high school. Early accurate diagnosis and appropriate surgical management are especially important for successful treatment of this previously fatal condition.

Growing skull fracture in childhood. A recurrent case treated by shunt operation

The authors report a case of growing skull fracture in which watertight dural closure was difficult at the first operation because a dural defect extended deep into the middle fossa. Bulging of the cranioplasty site occurred 2 months later. In the second operation, instead of reinforcement of the dura mater, a shunt operation was performed to decompress the cyst and the locally dilated ventricle, which was thought to contribute to the intracranial expansive forces. The bulging did not recur. In the treatment of growing skull fracture, a shunt operation should be considered when watertight closure of the dural defect cannot be achieved and in case of recurrence after failure of the first operation.

[Two cases of cerebral aneurysms combined with polycystic kidneys]

Two cases of cerebral aneurysm combined with polycystic kidneys (PCKs) were presented. Case 1, a 24-year-old hypertensive male, was referred to our clinic owing to sudden onset of severe headache at August 20, 1982. Neurological findings on admission were stuporous, right vitreous hemorrhage (so-called Terson's syndrome), and hypertension. CT scans showed subarachnoid hemorrhage, and right MCA bifurcation aneurysm with marked vasospasms by cerebral angiography was revealed. Intentional delayed operation with V-P shunt was performed. He discharged with mild left upper limb paresis, and visual impairment on the right. Bilateral PCKs were confirmed by postoperative DIP and CT scan. Case 2, a 51-year-old female, who suddenly complained of severe headache, was referred to our department 3 days after subarachnoid hemorrhage. One year previously, she had been pointed out PCKs. Neurological findings on admission at February 29, 1980, were drowsy, left third cranial nerve palsy, and hypertension. Cerebral angiography showed multiple aneurysms (bilateral IC-PC & A-com). Neck clipping (1-IC-PC & A-com) and coating (r-IC-PC) were performed at the next day of admission, and V-P shunt operation was followed about 8 weeks after first operation. About 2 weeks after discharge, she suddenly became loss of consciousness and expired. Autopsy revealed intracerebral hemorrhage in left basal ganglia and thalamus. Both kidneys were PCKs of Potter type 3 and cysts of the liver were also noted. In young hypertensive patients with cerebral aneurysms, it should be in mind whether PCKs may be combined or not, and cerebral angiography in PCKs were reasonable to find out harbored cerebral aneurysm.(ABSTRACT TRUNCATED AT 250 WORDS)

Chiasmal apoplexy. Report of four cases

Four patients with chiasmal syndromes were found to have intrachiasmal hematomas. Computerized tomography scans showed high-density suprasellar masses in all cases. Cryptic vascular anomalies were presumed to be responsible for spontaneous bleeding into the chiasm in three of the cases. In the remaining case, hemorrhage was due to an occult optic glioma. Surgical evacuation of clotted blood resulted in improved visual function in three of the four cases.

[A case of "true" posterior communicating artery aneurysm (author's transl)]

A 57-year-old woman complained of severe headache and vomiting of a week's duration. Spinal tap showed bloody CSF and cerebral angiography revealed the "true" posterior communicating artery aneurysm. Left frontotemporal osteoplastic craniotomy and trapping of the aneurysm were performed on August 28, 1979. After operation right hemiplegia, left oculomotor palsy and the disturbance of consciousness developed. Postoperative CT scan showed a hemorrhagic infarction at the left basal ganglia. Since then she has been getting better and was discharged, able to walk, from our hospital 6 months after operation. We considered the anatomical importance of perforating arteries from posterior communicating artery and propose that true posterior communicating artery aneurysm should be classified separately from our experiences and literature.

Five-year follow-up study of patients with persistent vegetative state

One hundred and ten patients with persistent vegetative state, were followed up for a period of five years from 1973 to 1978. Seventy-three per cent of the patients died during the period while about 10% of them recovered partially from the vegetative state. Among the recovered patients, only three became able to communicate, but two of these are not independent for their daily activites. Reactivity and clinical symptoms of 30 survivors were examined, but no great changes occurred during the last two years of the study.