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J Kumai

Publications and source records attributed to J Kumai.

8 recordsLinked to original sources
PubMed1996

[Vertebral artery dissection without subarachnoid hemorrhage studied by serial angiography].

We presented six cases we have encountered of vertebral artery dissection without subarachnoid hemorrhage followed by serial angiography. All six patients suffered from severe headache and/or nuchal pain at onset. Pain was acute at onset, with severe intensity and sharp quality and was located unilaterally on the dissection side. Only two patients showed neurological deficits. CT scan disclosed no abnormalities in any of the cases and angiography performed at the acute stage showed varied findings. The so-called pearl and string sign, which has been considered the most common finding of this disorder, was observed in only two cases. The definite diagnosis was able to be finally made by serial angiography. During the first few months after onset, dynamic changes of angiographical findings were demonstrated in all cases. During these periods, although transient deterioration of the angiographical findings was shown in four cases, spontaneous healing or improvement was finally recognized in all cases except one which progressed to total occlusion. In contrast to this, in the chronic stage, no changes of angiographical findings occurred in any of the cases. All six patients were treated non-surgically. All showed almost total recovery from symptoms and returned to their previous life styles. There were no cases of recurrent deterioration of symptoms in spite of the changes indicated by the angiographical findings. Our experience with these patients suggests that the actual incidence of vertebral artery dissection without subarachnoid hemorrhage may be much higher than is usually thought, and that the natural course of this disorder seems to be usually favorable. However, longer follow-up study and an analysis of a larger number of cases are required to identify the true incidence and the natural course of this disorder. In addition, we would like to emphasize that accurate diagnosis is most important. If it is clinically suspected, careful investigations including serial angiography should be carried out for the diagnosis of this disorder.

Adult↗
PubMed1996

[Recurrence of a giant fusiform aneurysm after neck clipping: case report].

The patient was a 71-year-old female. On December 20, 1995, she suddenly developed a severe headache with vomiting and was transferred to our hospital. On admission, her conciousness level was 1-2 on the Japan Coma Scale, but there was no neurological deficit except for right oculomotor palsy. Computed tomography showed subarachnoid hemorrhage which had permeated the right lateral ventricle. On cerebral angiography, a giant fusiform aneurysm in the right internal carotid artery was recognized. During the emergency operation, neither neck clipping nor carotid reconstruction was possible because of the tight adhesion of the aneurysm to the peripheral tissue. On account of this, proximal clipping of the carotid artery with external carotid-middle cerebral artery anastomosis with saphenous vein graft was selected. This patient had had an episode of subarachnoid hemorrhage owing to rupture of the right internal carotid-posterior communicating artery aneurysm ten years earlier. At that time, the aneurysmal neck was clipped with a slight residual neck and she left the hospital on foot. Five days later, when the aneurysm was found to be completely thrombosed on CT scan, antiplatelet therapy was started. Although low density areas which corresponded to the regions fed by the right anterior choroidal artery were presented, re-rupture did not occur. Follow-up angiography showed that the aneurysm was completely thrombosed and that the right middle cerebral and the anterior cerebral artery blood was circulated via the vein graft. Among recurrent cases of aneurysm after neck clipping, it is unusual for a giant fusiform aneurysm to be recognized. The growth may have been caused by sclerotic change of the arterial wall. Oculomotor palsy may have delayed the detection of the recurrence of the aneurysm. When residual neck is presented on follow-up angiography, the next angiography should be carried out within at least three years. In this case, antiplatelet therapy was effective to prevent thromboembolism from the aneurysm.

Aged↗
PubMed1995

[A case of pineoblastoma successfully treated with surgery, combined chemotherapy of cisplatin and etoposide, and radiotherapy].

A 5-year-old girl was admitted to another clinic because of vomiting and convulsions. She was brought to our clinic after a ventriculoperitoneal shunt was inserted. CT scan on admission in our clinic showed a tumor in the pineal region with tumoral hemorrhage. Tumor markers such as HCG, AFP, CEA, P-LAP were within normal range. A biopsy of the tumor was performed and the histological diagnosis was pineoblastoma. Her recovery was excellent and disseminated metastasis was not recognized. A subtotal removal of the tumor was performed through the occipital transtentorial approach. She had no neurological deficits after surgery. She then received two 5-day cycles of chemotherapy, consisting of intravenous administration of 20 mg/m2/day cisplatin and 60 mg/m2/day etoposide, and craniospinal radiotherapy. After these therapies, the tumor responded and disappeared completely. Follow-up radiographic investigations also demonstrated no abnormal evidence except for brain atrophy. She is attending a primary school without any problems. Pineoblastoma is quite rare and remarkably malignant. Hence, aggressive therapies including surgery, radiotherapy and chemotherapy is indicated for this tumor.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

[Infantile brainstem infarction due to vertebral artery fenestration: a case report].

The patient was a 10-year-old boy. He had a sudden onset of generalized tonic-clonic convulsion. On admission, he presented with mild disturbance of consciousness and right hemiparesis. The electroencephalogram showed diffuse spike and slow wave complex. Three days later, magnetic resonance imaging (MRI) showed high signal intensity areas in the left cerebellar hemisphere and pons. On cerebral angiograms, coiling of the bilateral carotid arteries, occlusion of the basilar artery at the distal site, and fenestration of the left vertebral artery at the atlanto-axis level were shown. According to these findings, the patient was diagnosed with brainstem and cerebellar infarction. On the follow-up angiograms, recanalization of the basilar artery on the right vertebral angiogram, occlusion of the left vertebral artery at the distal site of the posterior inferior cerebellar artery origin, and occlusion of one of the duplicated vertebral arteries were recognized. Fenestration of the vertebral artery is presented in about 1-2% at angiography and autopsy and the clinical significance is controversial. In this case, the fenestration may have played a role as an embolic source because there was no probable cause of the cerebral infarction, and the vascular occlusion and recanalization occurred near the distal site of the fenestration. These findings suggest the clinical significance of vertebral artery fenestration as an embolic source.

Brain Stem↗
PubMed1993

[A case of xanthofibroma of the skull].

The authors describe a case of xanthofibroma of the skull. A 53-year-old female was admitted to our hospital in September, 1991, with subarachnoid hemorrhage due to a ruptured aneurysm of the anterior communicating artery. The roentgenogram of her skull incidentally revealed the presence of a radiolucent (a punched out) lesion of about 20 x 25 mm in the right occipital bone. On computed tomography (CT), the mass was seen to be mainly localized in the diploe, and the outer table of the skull was thinned. On both T1 and T2 weighted magnetic resonance image (MRI), the mass showed a high intensity signal equivalent to that found in adipose tissue. The bony tumor was totally removed. Histology revealed a collection of foamy cells, benign fibrous tissues and so on which led to a diagnosis of xanthofibroma of the skull without hyperlipidemia. Xanthofibroma of the skull is extremely rare. To our knowledge, including our case, only three cases have been reported.

Cerebral Angiography↗
PubMed1993

[Fibromuscular dysplasia with an internal carotid artery web on the angiograms].

A 58-year-old woman experienced a transient right-sided hemianopsia. She also had difficulty finding words and trouble naming parts of objects. On admission, three days later, there were no signs of residual neurological deficit. Laboratory studies showed findings of neither diabetes mellitus, hypertension nor cardiac disease. Her serum cholesterol level was normal. No bruit was heard over the head and neck. Preoperative angiograms showed a discrete web (septum) at the left internal carotid origin (Fig. 2). 123I-IMP SPECT revealed a decreased areas of perfusion mainly in the left middle cerebral artery distribution (Fig. 3A). A reconstructive operation was performed. A firm discrete nonatherosclerotic ridge (septum) protruding into the vessel lumen was resected. Microscopic examination of the surgical specimen demonstrated intimal fibroplasia, a rare subtype of fibromuscular dysplasia (FMD). Postoperatively, hypoperfused areas in SPECT were improved (Fig. 3B). The patient has been free of symptoms to the present time (for about one year). In addition to the rarity of the lesion, the available data suggest that web-like subtype of FMD is apt to be associated with an increase in the risk of hemodynamic compromise and thromboembolism. Surgical therapy is recommended, especially for symptomatic patients.

Carotid Artery, Internal↗
PubMed1992

Preserved spinal dorsal horn potentials in a brain-dead patient with Lazarus' sign. Case report.

The case of a brain-dead patient with complex movements of the extremities (Lazarus' sign) is reported. This is the first description in the literature of short-latency somatosensory evoked potentials (SSEP's) following median-nerve stimulation by a noncephalic reference method. The scalp P14 wave (a far-field positivity with a peak latency around 14 msec that originates from the cervicomedullary junction) disappeared, and the spinal N13 wave (a near-field negativity with a 13-msec peak recorded on the posterior neck and generated by the cervical dorsal horn) was preserved. Respiratory-like movement was also seen in this case. The SSEP. findings support the hypothesis that both Lazarus' sign and respiratory-like movement have a spinal origin.

Aged↗