PubMed Health⌕ Search

Biomedical subjects

C Ochiai

Publications and source records attributed to C Ochiai.

At least 19 recordsLinked to original sources
PubMed1998

Primarily extracranial jugular foramen neurinoma manifesting with marked hemiatrophy of the tongue: case report.

BACKGROUND: There have been no detailed descriptions of the clinical symptoms of a primarily extracranial jugular foramen neurinoma (JFN), because this type of tumor is extremely rare. CASE DESCRIPTION: Although the 51-year-old woman presented with only mild complaints of dysphagia and hoarseness, neurologic examination revealed marked left hemiatrophy of the tongue. Although magnetic resonance imaging suggested a JFN, the patient's mild symptoms and normal jugular foramen were potentially misleading in the diagnosis of this patient. Surgical exploration demonstrated that the tumor originated from the extracranial portion of the 10th cranial nerve, extending into the jugular foramen. Subtotal resection ameliorated the 12th cranial nerve palsy. CONCLUSION: The authors present a case of a primarily extracranial JFN manifesting as a 12th nerve palsy. The clinical symptoms and signs produced by a tumor in this extremely rare location are discussed.

Atrophy↗
PubMed1997

Significance of pupillary reactivity in poor-grade aneurysm patients as a prognostic factor and an indication for active treatment.

Sixty-eight patients with subarachnoid haemorrhage (SAH) who were admitted in a comatose state were studied to determine the factors influencing mortality and to seek criteria for case management. Overall, the functional recovery (good recovery or moderate disability) rate was 33%, with a mortality rate of 50%. Bilaterally unreactive pupils on admission was a powerful predictor of death (p < 0.0001): outcome of these patients was poor regardless of any treatment modalities with a mortality rate of 91% (20/22). Initial poor motor response (abnormal flexion, extension, or nil) was also significantly related with death (p < 0.05). However, motor response was a less powerful predictor than pupillary reactivity. Motor response often altered spontaneously during the 12 h after admission, whereas pupillary reactivity tended to be stable. Initial reactive pupils were shown to be an indicator of spontaneous improvement of motor response. These findings indicate that pupillary reactivity may be a reliable predictor of outcome in poor-grade SAH patients.

Adult↗
PubMed1997

Early fatal rebleeding from a cerebellar cavernous malformation--case report.

A 25-year-old female patient presented with hemorrhage from a cerebellar cavernous malformation manifesting as headache and vomiting. She died of massive rebleeding within 1 week of the previous hemorrhage. The natural history of cavernous malformations was considered relatively benign, with significant hemorrhage being uncommon. The present case suggests that emergency surgery should be performed for patients with unstable clinical conditions and/or those with a significant mass effect in the cerebellum or the brainstem.

Adult↗
PubMed1996

Cerebral aneurysms unrelated to arterial bifurcations.

The majority of saccular cerebral aneurysms arise at arterial branchings; those arising elsewhere are rare. Among 557 saccular cerebral aneurysms surgically treated between 1983 and 1994, 29 (5.2%) were unrelated to arterial divisions. These cases were retrospectively analysed. The ages of the subjects ranged from 6 to 80 years (mean 57); 17 (59%) were female, and 12 (41%) male. Twenty-four (83%) presented with subarachnoid haemorrhage. Seventeen (59%) had a history of hypertension, and ten (34%) had multiple cerebral aneurysms. The most common site was the internal carotid artery (45%), followed by the middle cerebral artery (28%), the vertebrobasilar arteries (17%), and the anterior cerebral artery (10%). The aneurysms were classified in relation to arterial curvature into three groups: dorsal curvature (41%), ventral curvature (10%) and non-curvature (49%). During surgery, sclerotic changes were noted in the arterial wall adjacent to the aneurysms in 14 patients (48%). Five cases (17%) had small thin walled (blister-like) aneurysms, four of which ruptured during surgery resulting in poor clinical outcomes. We suggest that arteriosclerotic changes in the arterial wall, carotid siphon, and/or local haemodynamic forces are important factors in the development of this type of aneurysms. At surgery, one should bear in mind the possibility of sclerotic or blister-like aneurysms which require special attention to deal with them.

Adult↗
PubMed1996

Dissecting aneurysm of the anterior cerebral artery causing hemorrhagic infarction.

BACKGROUND: Dissecting aneurysms of the cerebral arteries are infrequent, and they occur preferentially in the middle cerebral, internal carotid, and vertebrobasilar arteries. The anterior cerebral artery (ACA) is usually involved in association with dissection in other locations, but a lesion confined to the ACA is an extremely rare event. No previous reports have well documented the clinical and pathological features of the ACA dissection. Moreover, surgical management for this lesion has not been reported. CASE REPORT: A case of dissecting aneurysm confined to the ACA causing hemorrhagic infarction is presented. To prevent subsequent rupture, we employed a trapping procedure 12 days after the onset. A dark purplish discoloration of the right A2 portion was encountered, with an intact anterior communicating complex. The involved vessel was partly sectioned for further pathological examination. RESULTS: Pathologically, subintimal clots dissected the vascular lumen in the inner layer of the media. Other abnormalities such as deficiency of the internal elastic lamina and medial defects were not found. The postoperative clinical course was not eventful. CONCLUSIONS: This is the first case to document an ACA dissecting aneurysm treated by a direct surgical approach. Spontaneous resolution is not infrequent in cerebral dissection, but subsequent rupture has commonly resulted in poor outcome. Surgical management is thought to be the most effective method to prevent further hemorrhagic event, even for an ACA dissection. Revascularization distal to the compromised artery should be considered whenever necessary.

Cerebral Angiography↗
PubMed1996

Effects of a hydroxyl radical scavenger on delayed ischemic neurological deficits following aneurysmal subarachnoid hemorrhage: results of a multicenter, placebo-controlled double-blind trial.

A water-soluble, novel synthetic compound, AVS ((+/-)-N, N'-propylenedinicotinamide; nicaraven) has no demonstrable vasoactive properties but scavenges hydroxyl radicals in aqueous environmental conditions at neutral pH. Based on the results of preceding experimental and clinical studies showing marked ameliorative effects of AVS on cerebral vasospasm and ischemic brain damage, a multicenter, placebo-controlled double-blind clinical trial was undertaken to verify its beneficial effects on delayed ischemic neurological deficits (DINDs) due to vasospasm and on the overall outcome of patients with subarachnoid hemorrhage (SAH). A total of 162 patients with SAH who had Glasgow Coma Scale scores between 7 and 15 on admission were enrolled in the trial. Drug administration (4 g AVS or 4 g glucose as placebo; infused intravenously for 6-8 hours once a day) was begun within 5 days post-SAH and continued for 10 to 14 days. Intent-to-treat analysis of these patients revealed that the overall incidence of DINDs, which was defined as an exacerbation of impaired consciousness and/or focal neurological deficits, was significantly reduced, by 34.5% (placebo 54.2%, AVS 35.5%; p < 0.05, Mann-Whitney U-test). The Glasgow Outcome Scale (GOS) score at 1 month was significantly improved by AVS (p < 0.05, U-test). At 3 months, the difference in the GOS scores between the groups became marginal on U-tests (p < 0.10), but the percentage of good outcome tended to increase, with a relative increase of 20.3% (AVS 76.3%, placebo 63.4%; p < 0.10, chi-square test), and the cumulative incidence of death was significantly reduced (p < 0.05, log-rank test). No significant adverse reaction attributable to treatment was observed. the usefulness of AVS in therapy for SAH is strongly indicated by the fact that the agent significantly ameliorated DINDs, leading to a marked improvement in the GOS scores at 1 month, as well as a reduction in the cumulative incidence of death by 3 months.

Adult↗
PubMed1996

Bridged craniotomy for stable fixation of a bone flap. Technical note.

Postoperative depression of the bone flap is a common and bothersome problem in craniotomies. In this paper, a simple technique to avoid this deformity is described. The key to this technique is to leave uncut a part of each osteotomy approximately 5 mm in width as a "bridge" to the bone flap, which is then subsequently cut with the aid of a chisel. This technique provides stable fixation of the bone flap and satisfactory cosmetic results with little additional operating time.

Craniotomy↗
PubMed1996

[Diffuse ventricular enlargement outlines the late outcome of diffuse axonal brain injury].

Clinical significance of ventriculomegaly after severe head trauma has not been fully explored yet. We analyzed hospital records of 53 cases of diffuse axonal injury and 7 cases of brain concussion together. The follow-up periods ranged from 6 months to 8 years (average 25 months). Four patients underwent CSF shunting without noticeable effect. We classified their outcome according to our modification of the Glasgow outcome scale: vegetated, severe, moderate, mild, fair, and good. We reviewed initial (within 12 hours after injury) CT scans and late (3 to 6 months after injury) CT scans or MRI's. We measured the ratio of the third ventricular width to the inner diameter of the skull on the axial view. We computed the lateral ventricular volume by our newly-devised method which took the partial volume phenomenon into account. Temporary extracerebral fluid accumulation was noted mostly within 3 months after injury in 25 of 39 cases in the mild level or above, and 2 of the 9 fair or good level cases. Ventriculomegaly occurred early and stabilized around the 3 month period. We found the differences between the late and the initial values of the third ventricular width (%) and the lateral ventricular volume (cc) highly correlated with our outcome scale (Spearman's correlation coefficient rs = 0.531, 0.676, respectively with p < 0.001 unanimously). We found the late values themselves of the third ventricular width and the lateral ventricular volume highly correlated with our outcome scale (rs = 0.575, 0.650, respectively with p < 0.001 unanimously). These 4 parameters were also highly correlated with the duration of the initial unconsciousness (LOC). Thus, posttraumatic diffuse ventriculomegaly affecting the third ventricle as well should outline the late outcome of diffuse axonal injury. Both the ventriculomegaly and the late outcome should be roughly predicted by the duration of the initial unconsciousness.

Adolescent↗
PubMed1996

[Ruptured peripheral lenticulostriate artery aneurysm in a child: case report].

We report a 12-year-old with intracerebral hematoma and subarachnoid hemorrhage secondary to the rupture of a peripheral lenticulostriate artery aneurysm. We carried out proximal clipping of the lateral lenticulostriate artery at the middle cerebral artery following six days of continuous ventricular drainage for acute hydrocephalus. Postoperative angiography confirmed the obliteration of the aneurysm. The girl was discharged without any neurologic deficits. To our knowledge, this is a first reported case in the literature of a ruptured peripheral lenticulostriate artery aneurysm in childhood. The pathogenesis of such an aneurysm and the treatment modalities are discussed.

Aneurysm, Ruptured↗
PubMed1995

[Cerebral aneurysms associated with von Recklinghausen neurofibromatosis: report of two cases].

The authors reported two cases of aneurysms associated with von Recklinghausen's neurofibromatosis. The first case, a 60-year-old woman was referred to our hospital because of disturbance of consciousness and right hemiparesis of acute onset. On admission, she was almost alert but developed right hemiparesis and lower cranial nerve palsy. Computed tomographic (CT) scanning and magnetic resonance imaging (MRI) demonstrated a huge mass compressing the brain stem and another mass lesion in the suprasellar cistern. Cerebral angiography disclosed left vertebral and left internal carotid artery giant aneurysms. Since she suffered respiratory distress because of aspiration pneumonia, conservative therapy was carried out. However, she developed cardiac arrest suddenly and died fourteen days after admission. On autopsy, it was shown that the left sided medulla oblongata had necrosis due to compression by the giant aneurysm and that the hemorrhagic infarction of the left cerebellar hemisphere was caused by a thrombus from the giant aneurysm of the left vertebral artery. The second case, a 40-year-old woman presented a disturbance of consciousness. A CT scanning demonstrated subarachnoid hemorrhage with a thick hematoma in the left sylvian fissure. An aneurysm at the junction of the right internal carotid artery and the posterior communicating artery was found, while the left middle cerebral artery was shown to be normal on cerebral angiography. Additionally an arteriovenous fistula of the left vertebral artery was found. Although no aneurysm was seen in the territory of the left internal carotid artery, left sided craniotomy was performed based on the CT findings.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Proliferative potential and malignant transformation of ganglioglioma: immunohistochemical studies by MIB-1 and p53 staining.

We studied two cases of ganglioglioma immunohistochemically by MIB-1 and p53 staining. The positive rate of MIB-1 in the ganglionic cells was 5.5% in Case 1 and 7.8% in Case 2, and that of MIB-1 in the gliomatous cells was 1.4 and 6.6% respectively. The labeling index of p53 in the ganglionic cells was 7.3% in Case 1 and 7.7% in Case 2, and that of the gliomatous cells was 1.9 and 3.4% respectively. MIB-1 and p53 did not stain ganglionic precursor cells. These results indicate that the ganglionic cells also take part in proliferation and have potential of malignant transformation.

Aged↗
PubMed1994

[A distal posterior inferior cerebellar artery aneurysm in the fourth ventricle: a case report].

The authors reported a case of a fourth ventricle aneurysm originating from the choroidal branch of the posterior inferior cerebellar artery (PICA). A 65-year-old woman became comatose following the acute onset of a severe headache and vomiting. She was moribund on admission, showing decerebrate posture. CT scan revealed a massive hematoma in the fourth ventricle up to the lateral ventricle. Extension of blood to the cisterna magna through the cerebellar vermis was also noted. Angiography demonstrated an aneurysm distally located on the right PICA across the midline. The aneurysm lodged in the choroid plexus which was exclusively fed by the right PICA was excised without difficulty through suboccipital craniectomy. Postoperative course was uneventful. She regained her full consciousness by two days after the operation, and was discharged with a minimal truncal ataxia. To our knowledge, this is the first report of a ruptured aneurysm developing in the choroid plexus of the fourth ventricle. Hemodynamic stress is speculated to be a causative factor of such a lesion.

Aged↗
PubMed1990

Efficacy of closed-system drainage in treating chronic subdural hematoma: a prospective comparative study.

The authors conducted a prospective comparative study on the recurrence rate of chronic subdural hematoma after the use of two different treatment modalities: burr-hole irrigation of the hematoma cavity with (Group A) and without closed-system drainage (Group B). Thirty-eight patients were studied. Patients were assigned to groups sequentially upon admission. There were no significant differences between the two groups for age, sex, preoperative hematoma volume, and density on computed tomographic scan. One patient in Group A (5%) suffered a recurrence as opposed to 6 in Group B (33%). The difference in recurrence rate between the two groups was statistically significant (P less than 0.05). The authors conclude that closed-system drainage after burr-hole irrigation reduces the recurrence rate of chronic subdural hematoma.

Aged↗
PubMed1990

Ruptured cerebral aneurysms missed by initial angiographic study.

The authors reviewed the computed tomographic (CT) scans of patients with subarachnoid hemorrhage whose initial angiograms were negative, to investigate the validity of CT scans in predicting the presence of an angiographically missed aneurysm in such patients. During the past 14 years, additional angiograms have been obtained for 38 of the 45 patients with subarachnoid hemorrhage whose initial angiograms disclosed no aneurysm. Aneurysms were found in 8 patients; 7 on the anterior communicating artery and 1 at the junction of the internal carotid and posterior communicating arteries. CT scans were taken within 4 days after subarachnoid hemorrhage in 31 patients. Analysis of these scans showed that the second angiogram revealed 1) an aneurysm in 21% of the patients with a thin layer of subarachnoid blood and in 63% of those with a thick layer; 2) no aneurysm in the patients without subarachnoid blood; and 3) an aneurysm of the anterior communicating artery in 70% of the patients who showed a considerable amount of blood in the basal frontal interhemispheric fissure. These results suggest that if CT scans show thin or thick subarachnoid blood, angiographic study should be repeated early in the course. If a considerable amount of blood is shown in the basal frontal interhemispheric fissure, it is highly probable that an aneurysm is hidden on the anterior communicating artery, even if the angiogram is negative for an aneurysm.

Adult↗
PubMed1989

Preoperative angiographical prediction of the necessity to removal of the anterior clinoid process in internal carotid-posterior communicating artery aneurysm surgery.

During the last 10 years, we had to resect the anterior clinoid process (ACP) before applying the clip in three of the 70 patients with internal carotid-posterior communicating artery (ICPCom) aneurysms. To reveal the angiographic characteristics in these three patients, we measured the following parameters on carotid angiograms in all 70 patients: 1) the angle between the midline of the skull and the axis of the C1 segment of the internal carotid artery (ICA) on A-P view (angle A). 2) the angle between the axes of the C1 and C2 segments of the ICA on A-P view (angle B). and 3) the distance between the posterior wall of the carotid "knee" and the proximal aneurysmal neck on lateral view (distance d). The common angiographic features of these three patients were as follows: 1) angle A was larger than 60 degrees. 2) angle B was less than 90 degrees. 3) distance d was less than 10 mm. and 4) the posterior communicating artery was of the foetal type. The present results suggest that preoperative angiogram can predict whether or not the ACP should be removed during ICPCom aneurysm surgery.

Carotid Artery Diseases↗
PubMed1989

Huge pineal teratoma mimicking a dermoid cyst. Case report.

A case of huge pineal teratoma mimicking a dermoid cyst is reported. Although both computed tomography and surgical findings were entirely similar to those of a dermoid cyst, close histological examinations using the serial sectioning technique of a small solid portion attached to the pineal region revealed tissue components of both mesodermal and entodermal origins among mostly epidermal and dermal components. The importance of serial sectioning of the surgical specimens of seemingly a dermoid cyst is stressed.

Adult↗
PubMed1987

[Primary intracranial epidermoid carcinoma accompanied with epidermoid cyst in the cerebellopontine angle--a case report].

A case of epidermoid carcinoma arising in an epidermoid cyst in the cerebellopontine angle is presented. Clinical features and CT appearance are discussed in comparison with those of benign epidermoid cyst. A 43-year-old man was admitted to the Department of Neurosurgery, University of Tokyo Hospital on April 14, 1983, with complaints of right facial numbness and weakness of six months' history. On neurological examination, sensation of the right half of the face was decreased in all modalities. Marked atrophy of the ipsilateral temporal muscle was also noted. Right facial paresis of peripheral type was evident. Gag reflex was decreased on the same side. Except for a slightly increased left deep tendon reflexes, there were no pyramidal tract signs. A CT without contrast material failed to show any abnormalities. A postcontrast CT demonstrated an irregular enhancement in the right cerebellopontine angle. The finding of asymmetry of the ambient cistern indicated minimum mass effect on the metrizamide CT cisternography. Suboccipital exploration of the right cerebellopontine angle was carried out on April 28, 1983. Leaving a part of the capsule indenting the pons between the roots of the fifth and the seventh nerve, we removed a white pearly tumor. Histological diagnosis was typical epidermoid cyst. He left the hospital one month later with signs of the right seventh and the eighth nerve. His postoperative course, however, was beyond our expectation. Over a few months following his discharge, left hemiparesis as well as horizontal and vertical nystagmus gradually developed. He was readmitted on November 10, 1983. A postcontrast CT revealed enlargement of the enhanced lesion filling the right ambient cistern.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗