Biomedical subjects

Michiharu Nishijima

Publications and source records attributed to Michiharu Nishijima.

18 recordsLinked to original sources

PubMed2006

Cavernous sinus dural arteriovenous fistula complicated by pontine venous congestion. A case report.

BACKGROUND: Brainstem venous congestion is a rare but serious complication of the CS-dAVF (cavernous sinus dural arteriovenous fistual). CASE DESCRIPTION: A 71-year-old woman presented with right abducens nerve palsy. Brain MRI showed a solitary lesion in the right upper pons. Cerebral angiogram revealed the right CS-dAVF with retrograde venous drainage into the cerebellar cortical veins and the anterior pontomesencephalic vein. The patient was treated with stereotactic radiosurgery, resulting in complete resolution of the pontine lesion and the neurologic symptom. CONCLUSION: A solitary brainstem lesion can be caused by CS-dAVF as a rare complication. Careful diagnosis and treatment are important to avoid permanent neurologic deficits.

Aged↗

PubMed2006

[Intracranial granulocytic sarcoma in a patient with acute myeloid leukemia].

Granulocytic sarcoma (GS) is extramedullary tumor composed of immature leukemic cells. GS is presenting usually as a complication during the course of hematologic neoplasm, such as acute myeloblastic leukemia as well as myeloproliferative and myelodysplastic syndrome. The tumor was also called chroloma based on the green color of the tumorous mass. Central nervous system manifestations of GS are extremely rare. We report a 41-year-old man with acute leukemia type M7, who developed GS in the right occipital lobe after complete remission was achieved. Operative findings revealed the color of the hard tumor was greenish, which suggested the tumor was chroloma. Histological findings showed the tumor was GS. The majority of reported cases of GS in acute myeloid leukemia were M2 FAB classification and have chromosome translocation. Our patient was M7 FAB classification, not have specific chromosome translocation. GS occurrence in AML: M7 patient was extremely rare. This is the first case report of AML: M7 with GS in the central nervous system.

Adult↗

PubMed2006

[Retrospective analysis of effects and complications in cases treated with endoscopic evacuation of intracerebral hemorrhage].

We described our experience of 22 cases treated with endoscopic evacuation of intracerebral hematoma, including 16 putaminal, 3 thalamic, and 1 cerebellar hemorrhages. All endoscopic procedures were performed under local anesthesia. A rigid-rod endoscope and a suction device attached was introduced through a transparent sheath into the hematoma cavity. Putaminal hemorrhage was sufficiently evacuated (56-100%), but thalamic hemorrhage was insufficiently removed (less than 40%). In 3 cases, postoperative CT demonstrated enlargement of the hematoma after the endoscopic procedure. In one case, postoperative rebleeding was recognized on a postoperative follow-up CT scan. In 2 cases, uncontrollable arterial bleeding occurred during the endoscopic procedure, followed by craniotomy and removal of the hematoma under a microscope. Endoscopic hematoma evacuation should be an efficient procedure for intracerebral hemorrhage after a secure method of hemostasis during the endoscopic evacuation process has been developed.

Adult↗

PubMed2005

Peculiar venous lesions in fatal hyponatremic brain edema.

A 19-year-old woman with a 3-year history of schizophrenia suddenly began to vomit, and rapidly developed a coma an hour after the onset of vomiting. A brain CT scan showed diffuse brain edema with compression of the ventricles. Laboratory tests showed a low serum sodium concentration of 117 mmol/L. She died 67 h after the onset of the first symptom. A postmortem examination showed diffuse swelling of the brain with bilateral uncal and tonsillar herniations. Histologically, no necrotic, hemorrhagic or encephalitic changes were seen. However, microvacuolar changes with lymphocytic infiltration were found in the venous walls (media and adventitia) mainly in the basal ganglia, thalamus and brainstem. To our knowledge, this is the first demonstration of venous alterations in fatal hyponatremic brain edema. These changes may have participated in the exacerbation of the brain edema due to functional disturbance of venous drainage.

Adult↗

PubMed2005

[A case of the lateral ventricle lesion mimicking arachnoid cyst treated by neuroendoscopic surgery].

A 12-year-old female suffered from intermittent headache with nausea. Neuroradiologic studies demonstrated a cystic lesion in the right trigone with content like cerebrospinal fluid. The right inferior horn was isolated and increased in size. Eodoscopic fenestration was attempted using a flexible fiberscope via the inferior horn. Postoperative magnetic resonance image revealed shrinkage of the cyst and reduced size of the right inferior horn. Intermittent headache dissapeared. Neuroendoscopic treatment is a less invasive and effective therapy for intraventricular arachnoid cyst as well that in the other intracranial lesion.

Arachnoid Cysts↗

PubMed2004

Cavernous angioma presenting as epilepsy 13 years after initial diagnosis.

A 22-year-old man presented with tonic-clonic seizure and was admitted to our hospital. He had suffered from frequent headaches, and had been diagnosed with a brain tumour on MRI 13 years ago. However, neither further examination nor follow-up neuroimaging study have been performed. Computed tomography and magnetic resonance imaging demonstrated an intraaxial tumor with granular calcification in the right frontal lobe, attached to the adjacent dura mater, which was enlarged compared with the lesion on CT 13 years before. The lesion was surgically excised through right frontal craniotomy. Histopathological analysis indicated cavernous angioma. In cavernous angioma in younger children, more aggressive surgical indications than in adults may be favorable both to prevent haemorrhagic complications and to confirm pathologic diagnosis.

Adult↗

PubMed2004

Supratentorial dynamic computed tomography for the diagnosis of vertebrobasilar ischemic stroke.

Dynamic computed tomography (CT) is an established method for the evaluation of perfusion in acute ischemic stroke, but is not frequently used to assess infratentorial ischemia. Eleven patients with vertebrobasilar ischemia underwent dynamic CT on admission and/or during the follow-up period. The time of appearance (TA) and time to peak (TTP) were mapped and differences in TA (deltaTA) and TTP (deltaTTP) between the bilateral middle cerebral artery and posterior cerebral artery (PCA) territories were calculated. Conventional angiography and brain imaging including CT and magnetic resonance imaging were also performed. The TA and TTP maps obtained within 48 hours after onset exhibited time delay in eight of nine patients in the bilateral PCA territories. deltaTA and deltaTTP were greater in patients with stenosis or occlusion of the bilateral vertebral arteries or the basilar artery, and in patients without collateral circulation via the posterior communicating arteries than in control subjects. Furthermore, TA and TTP normalized dramatically in patients with recanalization of the arteries. deltaTA and deltaTTP were also normalized. deltaTA and deltaTTP were negatively correlated with the time from onset to examination. Dynamic CT can provide important information in patients with vertebrobasilar ischemic stroke, and may allow the diagnosis of acute ischemia and monitoring of the course.

Aged↗

PubMed2004

[Endovascular treatment of a ruptured aneurysm associated with unilateral moyamoya disease].

We report a case presenting with subarachnoid hemorrhage due to a ruptured aneurysm associated with unilateral moyamoya disease. The patient was a 29-year-old woman exhibiting sudden onset headache. Computed tomography revealed subarachnoid hemorrhage around the brain stem. Cerebral angiography showed a saccular aneurysm at the junction of the left P1 portion of the posterior cerebral artery and its perforator. The right internal carotid artery was occluded at the terminal portion, and the right middle cerebral artery territory was perfused anterogradely via abnormal moyamoya vessels in the basal ganglia. The aneurysm was completely embolized with preservation of the perforator. We suggest that as compared to surgical clipping by craniotomy, endovascular therapy is safe and effective for treatment of intracranial aneurysms associated with moyamoya disease.

Adult↗

PubMed2004

[A case of superficial siderosis following subtotal removal of pituitary adenoma].

Superficial siderosis of the central nervous system (SS) is a rare clinical syndrome due to repeated intracranial hemorrhage. We report a case of SS occurring 19 years after subtotal removal of a non-functioning pituitary adenoma. The patient was a 37-year-old female, exhibiting progressive bilateral sensory neural hearing loss and cerebellar ataxia. T2 weighted magnetic resonance imaging demonstrated a rim of low intensity signal on the cerebellum, brain stem, and sylvian fissure. Immediate diagnosis based on characteristic symptoms and MRI findings is important for the prevention of irreversible progression of SS.

Adenoma↗

PubMed2004

[A case of young adult presenting with cerebral infarction caused by homocystinuria].

Homocystinuria is a congenital metabolic disorder, and has been known as life-threatening risk factor of vascular disease including ischemic stroke. We report a case of cerebral infarction due to homocystinuria. The patient was a 21-year-old woman exhibiting left hemiparesis and a previous history of ectopia lentis. Magnetic resonance imaging showed multiple fresh infarctions in the right frontal and temporal lobes, basal ganglia, corona radiata, and internal capsule. The right common carotid angiogram demonstrated complete occlusion at the origin of the right internal carotid artery. Further investigation clarified increased level of serum methionine and homocysteine and urinary homocystin due to cystathionine beta-synthase deficiency. Homocystinuria was diagnosed as the cause of cerebral infarction. The patient was treated by low methionine diet and administration of folic acid, cobalamin, and aspirin. It should be recognized that some patients with homocystinuria are missed in the neonatal screening for congenital metabolic disorders. Recent studies indicated that the homocysteinemia is one of risk factors of ischemic stroke in the general population as well as in the patients of homocystinuria. We recommend metabolic screening for homocystinuria, when treating a juvenile patient with ischemic stroke of unknown etiology.

Adult↗

PubMed2003

Structural and functional characterization of mouse glutamate decarboxylase 67 gene promoter.

Neuronal expression of the mouse glutamate decarboxylase 67 (mGAD67) gene occurs exclusively in neurons that synthesize and release GABA (GABAergic neurons). This gene is also expressed in pancreatic islet cells and testicular spermatocytes. In order to elucidate the molecular mechanisms underlying the regulation of mGAD67 gene expression, we isolated and characterized the 5'-flanking region of this gene. Sequence analysis of a 10.2-kb DNA fragment of this gene containing a promoter region (8.4 kb) and noncoding exons 0A and 0B revealed the presence of numerous potential neuron-specific cis-regulatory elements. Functional analysis of the 5'-flanking region of exons 0A and 0B by transient transfection into cultured cells revealed that the region -98 to -52 close to exon 0A is important for the transcriptional activity of both exons 0A and 0B. In addition, we used transgenic mice to examine the expression pattern conferred by the 10.2 kb DNA fragment of the mGAD67 gene fused to the bacterial lacZ reporter gene. Transgene expression was observed in neurons of particular brain regions containing abundant GABAergic neurons such as the basal ganglia, in pancreatic islet cells and in testicular spermatocytes and spermatogonia. These results suggest that the 10.2 kb DNA fragment of the mGAD67 gene contains regulatory elements essential for its targeted expression in GABAergic neurons, islet cells and spermatocytes.

5' Flanking Region↗

PubMed2003

Vertebrobasilar artery dissection presenting with simultaneous subarachnoid hemorrhage and brain stem infarction: case report.

BACKGROUND: Intracranial dissecting aneurysms have been associated with subarachnoid hemorrhage (SAH) or cerebral ischemia. We encountered a patient presenting with simultaneous subarachnoid hemorrhage and brainstem infarction caused by a dissecting aneurysm of the vertebrobasilar artery, which was diagnosed by magnetic resonance imaging (MRI) but did not show abnormal findings on cerebral angiography. CASE DESCRIPTION: A 55-year-old man had sudden onset of headache and left abducens palsy. Computed tomography revealed a subarachnoid hemorrhage localized in the left prepontine cistern and the left cerebellomedullary fissure. Cerebral angiography showed neither a saccular aneurysm nor fusiform dilatation causing the subarachnoid hemorrhage. MRI demonstrated a small infarction in the left dorsal pons, and an intramural hematoma of the left vertebral artery and lower basilar artery. CONCLUSION: This is a rare case of a vertebrobasilar dissecting aneurysm that simultaneously caused both SAH and brain stem infarction. MRI should be performed in the acute phase of SAH of unknown origin to determine the possible coexistence of a dissecting aneurysm, as occurred in this case.

Aortic Dissection↗

PubMed2003

Fatal rupture following intra-aneurysmal embolization for the distal posterior inferior cerebellar artery aneurysm with parent artery preservation.

This 70-year-old female was admitted to our hospital 1 day after a sudden consciousness disturbance. Computed tomography (CT) showed subarachnoid hemorrhage (SAH), and angiogram revealed an irregular-shaped aneurysm at the lateral medullary segment of the left posterior inferior cerebellar artery (PICA). The patient was treated by intra-aneurysmal embolization with Guglielmi detachable coil (GDC) with parent artery preservation. Post-operative angiogram showed obliteration of the aneurysm except for the neck remnant, but she presented with rerupture 19 days after the onset and died 3 days later. Postmortem examination revealed massive hematoma around the aneurysm, which compressed medulla oblongata from behind. Histological assessment showed the 'entry' where the aneurysmal wall lacked internal elastic lamina, providing evidence of dissecting aneurysm. The present case suggests that embolization of distal PICA aneurysm with parent artery preservation should be avoided because radiological evaluation may fail to rule out the possibility of dissection, where the aneurysmal wall is affected not only at the 'entry' but also in the adjacent region.

Aged↗

PubMed2003

Optochiasmal arachnoiditis following cotton wrapping of anterior communicating artery aneurysm treated by surgical removal of granuloma.

We report the case of a 50 year old female who presented with visual disturbance due to optochiasmal arachnoiditis and foreign body granuloma 9 months after cotton wrapping for ruptured anterior communicating artery (AcomA) aneurysm. Magnetic resonance imaging (MRI) revealed enhanced mass lesion around AcomA complex and hyperintense signal on optic chiasm and right optic tract by fluid-attenuated inversion recovery image. Despite the repeated steroid pulse therapy, she deteriorated and MRI showed expansion of the granulomatous lesion over 5 months. Surgical removal of foreign body granuloma resulted in marked improvement of visual disturbance as well as of the MRI findings. We conclude that the use of cotton sheet close to the optic nerve should be avoided, and that surgical removal of the granuloma would be the optimal choice especially for the patient in whom steroid therapy fails to improve clinical symptoms.

Arachnoiditis↗

PubMed2003

[A case presenting with hydrocephalus and posterior fossa subdural effusion].

We report a case of hydrocephalus due to posterior cranial fossa subdural effusion. The patient was a 4-year-old boy, presenting headache and nausea, with a medical history of viral meningitis 2 months before. Cerebrospinal fluid provided no evidence of infection, and symptoms caused by increased intracranial pressure gradually deteriorated, although glycerol infusion was effective temporarily. Computed tomography revealed marked ventriculomegaly with subdural effusion in the right posterior cranial fossa. The subarachnoid space in the posterior fossa was very tight, and the cerebellum and brain stem were compressed anteriorly. Magnetic resonance imaging demonstrated stenosis of the aqueduct and foramens of Luschka and Magendie. The cerebeller tonsil was dislocated inferiorly, indicating impending herniation, so an emergency operation was performed. Ventriculoperitoneal shunt was undertaken after implantation of an Ommaya reservoir for the posterior fossa subdural effusion. The patient's postoperative course was uneventful, and the symptoms were improved. Although hydrocephalus and subdural effusion following viral meningitis is rare, neuroimaging studies such as CT and MRI should be examined when a young child suffers from symptoms of increased intracranial pressure.

Catheters, Indwelling↗

PubMed2002

Lipophilic fraction of Panax ginseng induces neuronal differentiation of PC12 cells and promotes neuronal survival of rat cortical neurons by protein kinase C dependent manner.

Panax ginseng is a traditional Chinese herb with a wide range of therapeutic benefits. Recent studies focusing on its effect on the central nervous system have revealed that ginseng has neurotrophic effects including differentiation of neurons. However, most studies involve use of the water-soluble fraction called saponin, and little is known about the effect of the lipophilic fraction. In the present study, we have shown that the lipophilic fraction of ginseng at a concentration of between 0.1 and 50 microg/ml can induce neurite outgrowth of PC12 cells in a dose-dependent manner. Nearly all cells showed morphological differentiation in response to the lipophilic fraction. This morphological differentiation of PC12 cells appeared to be similar to that of NGF. The lipophilic fraction of ginseng also induced neurite extension and promoted survival of rat cortical neurons at a concentration of between 0.025 and 1 microg/ml. These neurotrophic effects on PC12 cells and cortical neurons were not inhibited by K252b, which selectively blocks neurotrophin actions by inhibiting trk-type receptor tyrosine phosphorylation. This suggests that trks do not participate in the neurotrophic action of the lipophilic fraction. However, the effects were completely attenuated by sphingosine, polymyxin B or staurosporin, known inhibitors of protein kinase C (PKC) and calmodulin-dependent kinases. Our results suggest that the lipophilic fraction of ginseng exerts its neurotrophic effects via PKC-dependent pathways.

Animals↗

PubMed2002

A case of calvarial eosinophilic granuloma with rapid expansion and wide skull invasion: immunohistochemical analysis of Ki-67.

A 15-year-old male visited our neurological service with progressive occipitalgia. Computed tomography showed an osteolytic lesion at the occipital cranium, which grew rapidly during a month. Magnetic resonance imaging showed the lesion as low intensity on T1- and high intensity on T2-weighted images. The mass was soft and successfully removed with surrounding cranium. Histological examination revealed an eosinophilic granuloma with wide skull invasion. Immunohistochemical analysis on the specimen disclosed Ki-67 expression with labeling index of 6.2%. Relatively high proliferative activity in the present case indicates that the local replication of Langerhans' cells as well as inflammatory response contributes to the expansion of calvarial eosinophilic granuloma. This is the first report demonstrating the result of Ki-67 expression on calvarial eosinophilic granuloma.

Adolescent↗

PubMed2002

[A case presenting brain abscess with multiple infectious aneurysms].

We report a case presenting a brain abscess with multiple infectious aneurysms. A 59-year-old man was transferred to our hospital suffering from left hemiparesis. MRI demonstrated a huge mass in the right frontal lobe with marked brain edema in the surrounding area. Diffusion-weighted image revealed heterogenous intensity, which is not typical in cases of brain abscess. Surgical removal was planned, and preoperative angiography was performed. Angiography demonstrated aneurysms at the distal branch of both the right middle cerebral artery and the anterior cerebral artery. These aneurysms were surgically resected, and the abscess was totally removed. Postoperative course was uneventful. Left hemiparasis was resolved, and there was no ischemic lesion seen on postoperative MRI. In the treatment of brain abscess, stereotactic aspiration has recently been preferred to removal by craniotomy. We conclude that cerebral angiography might be necessary to evaluate cerebrovascular complications including infectious aneurysms, in cases presenting atypical findings in neuroimaging study.

Aged↗