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Biomedical subjects

H Nukui

Publications and source records attributed to H Nukui.

At least 73 records · Page 4Linked to original sources
PubMed1991

[Superior sagittal sinus thrombosis complicated with multiple aneurysms presenting as subarachnoid hemorrhage. Case report].

A 48-year-old female suffered from severe headache, vomiting, and disturbance of consciousness. On admission, she was somnolent with mild paresis of the left leg. Precontrast computed tomography (CT) scans showed a high-density area in the left sylvian fissure and the posterior horn of the left lateral ventricle. Angiographically, a right middle cerebral artery aneurysm and a basilar artery aneurysm were recognized. Furthermore, on the venous phase of bilateral carotid angiograms, superior sagittal sinus (SSS) thrombosis was recognized. Subarachnoid hemorrhage (SAH) was probably induced by rupture of a dilated vein associated with SSS thrombosis, because high-density area on CT scan and location of the aneurysms were different. The patient was initially treated conservatively. Two months later, craniotomy was performed which did not disclose any trace of hemorrhage around the aneurysms and aneurysms themselves. Postoperatively, acute brain swelling and generalized convulsion were induced. The patient became ambulatory 5 months after surgery. In SAH cases, the venous phase should be examined at least in one side of the carotid arteries. In such a SAH case induced by venous thrombosis complicated by aneurysms it is very difficult to decide the timing of surgery for aneurysms.

Cerebral Angiography↗
PubMed1991

[Organized chronic subdural hematoma; report of two cases].

Two cases of organized chronic subdural hematoma were presented. The first case had a one-year history of disorientation and right hemiparesis. CT scan revealed a low density area with linear high density in its medial margin, suggesting chronic subdural hematoma on the left frontal convexity. Surgery was performed expecting to remove the hematoma. There was, however, only a little fluid inside with thick membranous tissue. The second case, who has Crouzon disease, presented a one-year history of pseudobulbar palsy and tetraparesis after surgery for chronic subdural hematoma and hydrocephalus. The diagnosis of organized subdural hematoma was made at the time of reoperation which was performed expecting to remove the recurrent chronic subdural hematoma. Plain CT, done after admission to our hospital, showed homogeneous low density area remaining in the bilateral frontal convexity. Infusion scan revealed marked enhancement of the medial margin of the low density area. The lesion was demonstrated as a low intensity area by T1-weighted magnetic resonance images (MRI). Marked enhancement was noted around the low intensity area after the infusion of Gd-DTPA. Although it is very hard to make a diagnosis of organized chronic subdural hematoma using only the CT scan preoperatively, combination of the CT scan and MRI with Gd-DTPA enhancement seemed to be very useful for this purpose.

Adult↗
PubMed1990

Cerebral amyloid angiopathy as a cause of subarachnoid hemorrhage.

Cerebral amyloid angiopathy is a pathologic condition characterized by the deposition of amyloid in the walls of small vessels in the cerebral cortex and meninges. Intracerebral hemorrhage is common in persons with this condition, but pure subarachnoid or subdural hemorrhage is rarely seen. Recently, the existence of two types of amyloid proteins related to cerebral amyloid angiopathy, beta protein and cystatin C, has been reported, and immunohistochemical methods using antisera to these proteins have become available. We describe a patient with fatal subarachnoid hemorrhage presumably caused by beta protein-type cerebral amyloid angiopathy, which was demonstrated immunohistochemically by using a monoclonal antibody to a synthetic peptide corresponding to residues 8-17 of beta protein. We suggest that beta protein-type cerebral amyloid angiopathy is a possible etiologic factor in subarachnoid hemorrhage of unknown cause.

Aged↗
PubMed1990

Changes in coagulation and fibrinolysis and effects of ticlopidine and cisternal drainage in the acute phase following aneurysm rupture.

In this study, changes in blood coagulation and fibrinolysis in the acute stage of subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms were investigated, and the effects of the platelet aggregation inhibitor ticlopidine and cisternal drainage were evaluated. All of the 53 patients underwent early surgery, and 27 patients received ticlopidine postoperatively. Cisternal drainage was implemented in 15 cases of severe SAH treated after late 1986. Of the hematologic factors studied, the activated partial thromboplastin time, fibrin and fibrinogen degradation products, fibrinogen, and platelet aggregation rate were found to be abnormal in the acute phase of SAH, and the "intravascular factor" scale obtained was also noted to be significantly (p less than 0.01) related to the outcome. Ticlopidine was consistently effective in reducing platelet aggregation but had little effect on other blood parameters. Cisternal drainage resulted in a significantly (p less than 0.01) lower incidence of symptomatic vasospasm and higher rate of good outcome. These results suggest that ticlopidine therapy plus cisternal drainage is highly beneficial in SAH, and that coagulation and fibrinolysis data are useful in determining the prognosis.

Blood Coagulation↗
PubMed1990

[Ruptured cerebral aneurysm followed by primary intracranial malignant lymphoma: case report].

Reported herein is a case of ruptured anterior cerebral aneurysm followed by primary intracranial malignant lymphoma. A 73-year-old female was admitted to our hospital on October 20, 1986, with a severe subarachnoid hemorrhage. Microsurgery was performed immediately on the day of admission because cerebral angiography revealed bilateral distal anterior cerebral artery aneurysms. Consciousness gradually deteriorated due to cerebral vasospasm from the 3rd day following surgery. To protect the brain, corticosteroid (methylprednisolone 1500 mg, dexamethasone 252 mg) was administered for 26 days after surgery. In spite of treatment, in March 1987 neurological examination revealed akinetic mutism, but CT scan did not reveal any evidence of tumor. CT scan performed on May 2, 1987, revealed a mass lesion in the left frontotemporal lobes and left basal ganglia. Histological diagnosis of malignant lymphoma (diffuse, large-cell type) was obtained by stereotactic biopsy. Radiotherapy (41 Gy of 60Co) was carried out. The CT scan performed on August 26, 1987 revealed that the abnormal enhanced lesion had disappeared. However, neurological findings had not remarkably improved. The patient died of renal failure in February 1988, but tumor recurrence had not been noted in CT scans. Autopsy could not be performed. Whole body CT scan and 67Gd scintigram did not reveal any other tumors except in the brain. Ruptured cerebral aneurysm followed by primary intracranial malignant lymphoma is very rarely reported. In such cases, which have unusual clinical courses and CT findings, we recommend stereotactic biopsy to treat this kind of radiosensitive tumor. The connection between malignant lymphoma and immunosuppression has been considered.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Complete remission of recurrent glioblastoma multiforme following local infusions of lymphokine activated killer cells. Case report.

We report the case of a 26-year-old man in whom glioblastoma multiforme had recurred six months following a subtotal resection. Despite radiotherapy and a course of interferon beta and ACNU, the tumour increased in size (to 3 cm) and there was neurological deterioration. Treatment was then initiated with LAK cells, together with ACNU and interferon beta. After three courses of LAK cells, tumour size was markedly reduced, and at about six months the tumour had nearly disappeared on computed tomographic (CT) scans. At one year, and after nine courses of LAK cell therapy (total dose of 2.7 x 10(9) cells) infused via an Ommaya reservoir and supplemented by ACNU and interferon beta, the tumour has disappeared and the patient is considered to be in complete remission since 6 months. This marked response is thought to be due chiefly to LAK cell therapy. The relatively low dose administered was well-tolerated.

Adult↗
PubMed1989

Primary internal ophthalmoplegia due to head injury.

Six cases of internal ophthalmoplegia due to direct head injury are presented. All six patients had a dilated, nonreactive pupil. Four had no extraocular palsies or ptosis and two had partial extraocular palsies or ptosis. Disturbance of consciousness was absent or very mild, and all patients fully recovered within 1 to 7 days after the traumatic event. No patient had a history that suggested a cause for oculomotor nerve palsy, and emergency CTscans showed no mass lesions. The internal ophthalmoplegia was recognized immediately after trauma. Although minimal oculomotor nerve palsies due to unruptured intracranial aneurysms have been described, none of our patients complained of periorbital or retroorbital pain either before or after the trauma, which rules out intracranial aneurysms as the cause of the internal ophthalmoplegia. Therefore, we concluded that the internal ophthalmoplegia was due to direct head injury. The pathophysiological mechanism of the internal ophthalmoplegia appeared to be slight injury of the pupillomotor fibres on the ventromedial surface of the third nerve at the posterior petroclinoid ligament, which acted as the fulcrum due to the downward displacement of the brainstem at the time of impact.

Adult↗
PubMed1989

[Multiple myeloma manifesting as a solitary cranial tumor. Case report].

A 76-year-old female struck her head in the parietal region and noticed a soft scalp mass. Approximately 3 months later, the mass was enlarged and she was evaluated at a local hospital. Although the tentative diagnosis was old subcutaneous hematoma, incision of the scalp revealed not hematoma but rather a tissue and bony defect. On admission to the authors' institution, she was found to have a round, smooth, subcutaneous mass in the upper left parietal region. The tumor was about 5 cm in diameter and 4 cm in height, and was soft, nonpainful, and pulsatile. Plain X-rays revealed an osteolytic lesion in the left parietal bone. Computed tomography demonstrated a high-density lesion corresponding to the bony defect, which was homogeneously enhanced by contrast material. Left external carotid angiography showed the mass to be vascular, its main feeder being the middle meningeal artery. It was concluded that the tumor originated from the diploë. The tumor was subtotally removed, and histopathological examination showed it to be a plasmacytoma. Laboratory tests, including protein electrophoresis, disclosed hypergammaglobulinemia with M-spikes. Immunoelectrophoresis demonstrated a serum paraprotein of immunoglobulin G kappa specificity. Multiple myeloma diffusely involving bone is well known, but a soft mass alone with a bony defect in the cranial vault is very rare. The clinical features and treatment of silent, solitary masses associated with multiple myeloma are discussed.

Aged↗
PubMed1989

Epidermoid tumors of Meckel's cave: case report and review of the literature.

Lesions of Meckel's cave are extremely uncommon and difficult to diagnose. The symptoms and signs are variable, and the lesions may not appear on routine roentgenographic or computed tomographic examination. A patient with a small epidermoid tumor of Meckel's cave that was diagnosed by magnetic resonance imaging is herein reported. The epidermoid appeared as a low-intensity mass on the T1-weighted image and as a high-intensity mass on the T2-weighted image. Coronal sections defined the anatomic relationship to the trigeminal nerve. Preoperative recordings of the trigeminal sensory evoked response may be predictive of postoperative recovery of neurological deficits. Furthermore, intraoperative recording was extremely useful in avoiding inadvertent neurological injury. Review of the literature confirms the rarity of this lesion and the usefulness of magnetic resonance imaging in diagnosing it, although based on a limited number of cases.

Adult↗
PubMed1989

[N-isopropyl-p-[123I]iodoamphetamine early dynamic image with ring-type emission CT in cerebrovascular disease].

N-isopropyl-p-[123I]iodoamphetamine (IMP) SPECT was done in 14 patients with cerebrovascular disease. Immediately after injection of 3 mCi IMP, sequential 2 minutes SPECT images (dynamic images) were obtained for 15 minutes using a circular detector array emission tomographic system (Shimadzu SET-030W). Then standard SPECT images were obtained at 30 minutes (early images) and 5 hours (delayed images) using a rotating scintillation camera ECT system (GCA-601E, Toshiba). Two patients out of 14 studies showed discrepancy of the findings between dynamic images and early images; dynamic images revealed low uptake area though early images showed no defect. Possible mechanism of this phenomenon might be due to so called redistribution phenomenon occurred during obtaining early images. In conclusion, early dynamic images is useful in cases with slightly decreased cerebral blood flow.

Adult↗
PubMed1988

Intraoperative monitoring of the motor function: experimental and clinical study.

Manipulation of the lesions adjacent to the primary motor area or the motor pathway is troublesome for neurosurgeons because they lack an effective method to determine the primary motor area or to monitor motor function in the operative room. It will be of great value to establish a monitoring method of the corticospinal tract under general anaesthesia. We recorded the motor evoked potential (MEP) from direct motor cortex stimulation in cats and showed that it derives almost purely from the corticospinal tract. Then we used this technique during the operation of the resection of tumours near the primary motor area or the motor pathway. 1. Experimental study: Twenty adult cats were used in this study. Recording electrodes were flexible bipolar catheter electrodes inserted into the spinal epidural space. Stimulating electrodes were silver ball electrode on the cortex (anode) and needle electrode in the temporal muscle (cathode). Stimulation of 4-24 V, 5-10 Hz and 0.2 msec in duration were done and evoked potentials signals were averaged 60 to 512 times. MEP with multiple peaks was obtained that had a 112 msec conduction velocity in the spinal cord. We found the same signals from the stimulation of ipsilateral cerebral peduncle. Radiofrequency lesioning of ipsilateral cerebral peduncle produced a loss of MEP. These results show that MEP derives from the corticospinal tract. Significant wave form change, with components of short latency, was noted by the excessively intense stimuli. We supposed that superimposition of the signals from the extrapyramidal pathways, excited in the brain stem, results in this change.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

Long-term observations in cases with spontaneous carotid-cavernous fistulas.

Twenty-six cases with spontaneous carotid-cavernous fistulas were followed up for periods ranging between 4 months and 9 years 8 months. A complete regression of symptoms without reappearance for more than 6 months was noted in 19 cases, a marked improvement in 2 cases, and a moderate regression in 3 cases. In 2 cases, symptoms have continued for 9 years 8 months and for 1 year. The regression of symptoms was usually delayed in patients less than 60 years old, in cases in which the symptoms developed slowly, and in cases with multiple draining veins. According to our observations a regression of symptoms may occur after very slight changes of haemodynamics. Compression of the cervical carotid artery for a short time or a temporary occlusion of the carotid artery by a balloon catheter should be considered as the treatment of choice in the first instance in cases with spontaneous carotid-cavernous fistulas showing relatively low pressure and low flow shunt.

Adult↗
PubMed1987

Venous cerebral infarctions in an infant with chronic subdural hematoma.

An infant with multiple cerebral infarctions and chronic subdural hematoma is reported. The infarctions were found after repeated tappings of the hematoma. Angiography did not demonstrate any occlusion of the main arteries. The infarctions were thought to be caused by thrombosis of the hanging cerebral veins. The pathogenesis and significance of the venous infarctions in an infantile subdural hematoma are discussed.

Brain Injuries↗
PubMed1987

Symmetrical bilateral low-density lesions in the areas of supply by Heubner's arteries after aneurysm surgery.

Three patients with symmetrical bilateral low-density areas which were the perfusion territories of Heubner's arteries are reported. The infarctions were demonstrated on computed tomography after aneurysm surgery. Two of them had an anterior communicating artery aneurysm and the other one had multiple aneurysms of both sides. They were operated upon in the acute stage after subarachnoid haemorrhage. As common factors, a thick and diffuse subarachnoid haemorrhage, an acute-stage operation, temporary clips to bilateral A1 segments or the internal carotid artery and a relatively low systemic blood pressure during operation were found. From these findings we conclude that the pathogenesis of the infarctions was due to occlusive changes affecting Heubner's arteries bilaterally.

Caudate Nucleus↗
PubMed1987

Postoperative subdural fluid collections in neurosurgery.

After introduction of computed tomography (CT) scanning, subdural fluid collections (SFCs) have been more frequently detected. We encountered 1013 operated cases in which CT scans were performed at an early postoperative stage. Postoperative SFC occurred in 165 of the 1013 operated cases (17%). The incidence of SFC was highest in aneurysm surgery (47%), followed by neurovascular decompression (27%) and brain tumor surgery (22%). In aneurysm surgery, preoperative ventricular dilatation seemed to promote the occurrence of SFC. In tumor surgery, SFC occurred more frequently when the tumor existed in the sellar region. The SFCs decreased or disappeared in most cases on sequential CT scans, but increased in 27 cases. In the latter, maximum thickness of the SFC was seen between 20 and 30 postoperative days. Nineteen of the 27 cases had preoperative ventricular dilatation. Operation for SFC was performed in four cases with clinical symptoms and signs. Three of 169 cases developed into chronic subdural hematomas.

Brain↗