Biomedical subjects

T Inagawa

Publications and source records attributed to T Inagawa.

At least 37 records · Page 2Linked to original sources

PubMed1995

Intracerebral hematoma in patients with ruptured cerebral aneurysms.

BACKGROUND: Intracerebral hematoma from ruptured aneurysms is one of the unfavorable factors for outcome in patients with subarachnoid hemorrhage. In this study, the clinical characteristics of intracerebral hematoma in patients with ruptured aneurysms were examined. METHODS: The subjects were 512 patients who had been admitted by day 3 after aneurysmal rupture without episodes of rebleeding before the initial computed tomography (CT) scan. They were divided into two groups according to the findings of initial CT; groups 1 and 2 comprised patients with and without intracerebral hematoma, respectively. RESULTS: Of the 512 patients, intracerebral hematoma was observed in 98 (19%). The incidence of intracerebral hematoma was higher in patients with distal anterior cerebral and middle cerebral artery aneurysms, compared with those at other sites (both, p < 0.01). Interhemispheric, callosal, and temporal lobe/sylvian hematomas were observed more frequently in patients with anterior communicating, distal anterior cerebral, and middle cerebral artery aneurysms, respectively, than in those with aneurysms at other sites. The incidence of rebleeding was 22% in group 1 and 14% in group 2 (p < 0.05). Clinical grades on admission were higher and outcome at 6 months after onset was less favorable in group 1 than in group 2 (both, p < 0.01). The larger the intracerebral hematoma, the higher was the clinical grade and the less favorable the outcome. However, when comparing management and surgical outcome under the same clinical grades, there was no significant difference between the two groups. CONCLUSIONS: There was a close correlation between the site of hematoma and that of the ruptured aneurysm. Poor outcome in patients with intracerebral hematoma seems to be related to severity of clinical grade on admission.

Adult↗

PubMed1995

Effect of rapid spontaneous diminution of subarachnoid hemorrhage on cerebral vasospasm.

In patients with subarachnoid hemorrhage (SAH), the effect of clot removal on cerebral vasospasm is still in dispute. The purpose of this study is to investigate whether rapid spontaneous diminution of subarachnoid blood alleviates vasospasm. We analyzed the effect of diminution of SAH on vasospasm in 36 patients with SAH grades III-IV who were operated on by the same surgeon by day 6 after SAH. The diminution of subarachnoid blood became more apparent with shorter interval between hemorrhage and initial computed tomography (CT) scan, with increasing patient age, and with higher SAH grades. The incidences of angiographic vasospasm grades III-IV, permanent symptomatic vasospasm, and low-density area on CT scans decreased with the increase in the degree of diminution of subarachnoid blood. Permanent symptomatic vasospasm and low-density area on CT scans were found in 5 of 9 patients with no diminution, whereas they occurred only in 5 of 27 patients with diminution (p < .05). We concluded that spontaneous diminution of subarachnoid blood in the acute stage after SAH seems to reduce the severity of vasospasm.

Aged↗

PubMed1995

A case of traumatic internal carotid artery occlusion diagnosed by MRI.

The case of a 4-year-old boy with traumatic internal carotid artery occlusion is reported. This patient developed left upper limb monoparesis and convulsions 62 h after injury. Magnetic resonance imaging (MRI) showed absence of a flow void and a high signal in the C5 portion of the right internal carotid artery. The proximal side of the right carotid siphon was not demonstrated by MR angiography. Carotid angiography revealed occlusion of the right internal carotid artery about 2 cm distal from the cervical carotid bifurcation. MRI appears to be useful to diagnose traumatic internal carotid artery occlusion, especially in children.

Arterial Occlusive Diseases↗

PubMed1995

Study of aneurysmal subarachnoid hemorrhage in Izumo City, Japan.

BACKGROUND AND PURPOSE: Estimation of the actual incidence rate of subarachnoid hemorrhage and evaluation of the treatment require the inclusion of all patients in a defined geographic area. METHODS: During 1987 through 1992 in Izumo City, Japan, we estimated the incidence rate of subarachnoid hemorrhage by including dead-on-arrival patients and by further adding the results obtained after reviewing all death certificates registered in this city in the corresponding period. In addition, we compared the management and surgical outcomes in hospitalized patients from 1987 through 1992 with outcomes from 1980 through 1986. RESULTS: During 1987 through 1992, we diagnosed 123 patients as having subarachnoid hemorrhage. The crude and the age- and sex-adjusted incidence rates using the 1990 population statistics for Japan were 25 (95% confidence interval, 21 to 30) per 100,000/y and 23 (95% confidence interval, 19 to 28) per 100,000/y for all ages, respectively; these occurrences are the highest among those reported to date. Of these patients, 8% died before receiving medical attention, 27% in the first week, and 39% at 1 month. The survival curve for 2 years improved significantly from 1980-1986 to 1987-1992 in patients with admission grades 4 and 5 (P = .035) and in operated patients with preoperative grades 1 through 3 (P = .036). However, there was little improvement in the overall management results (P = .168), possibly because patients with high risk and/or old age were admitted and/or diagnosed more often in the latter period. CONCLUSIONS: The incidence rate of subarachnoid hemorrhage is much higher than that reported so far in the literature, and despite improvement of management and surgical therapy, the actual case-fatality rate is still high, mainly because of the high mortality rate directly associated with the primary bleeding.

Adult↗

PubMed1995

Surgical removal of pineal region meningioma--three case reports.

Three patients with large or huge meningiomas of the pineal region presented with headache, vomiting, gait and visual disturbance, apraxia, agnosia, and transient amnestic aphasia. Computed tomographic scans revealed round, high-density areas of 8 x 7 x 7 cm, 5 x 5 x 4 cm, and 3 x 3 x 3 cm in the pineal region. Angiography revealed that the bilateral internal cerebral veins and the great vein of Galen were stretched and significantly displaced upward in one patient, and downwards in the other two. The meningiomas appeared to originate from the verum interpositum and falcotentorial junction, respectively. The tumors were removed subtotally or totally via an occipital interhemispheric transtentorial approach and/or infratentorial supracerebellar approach. The postoperative courses were uneventful, and no neurological deficit was detected postoperatively. Pineal region tumors with a maximum diameter of 5 cm or larger should be operated on via a unilateral or bilateral occipital interhemispheric transtentorial approach, regardless of the angiographic findings, because this permits a wide operative field and can be followed, if necessary, by an infratentorial supracerebellar approach. Selection of the operative approach for a relatively small pineal region tumor should depend on the angiographic findings: downward displacement of the bilateral internal cerebral veins and the great vein of Galen indicates an occipital interhemispheric transtentorial approach, whereas upward displacement indicates an infratentorial supracerebellar approach.

Adult↗

PubMed1995

[A case of cranial metastasis of hepatocellular carcinoma].

A case of cranial metastasis of hepatocellular carcinoma is reported. A 77-year-old woman with an elastic hard tumor in the right temporal region was referred to our department on April 30, 1992. On admission, the patient had slight weakness of the left upper limb. Plain skull X-ray and computed tomography (CT) showed bone destruction in the right temporal region. Magnetic resonance images (MRI) showed that the tumor was hypo-intense with T1-sequences and hyper-intense with T2-sequences, and included hyper-intense spots on both T1- and T2-images. Right carotid angiography showed that the tumor was fed by the middle meningeal and accessory meningeal arteries. The patient became disoriented, and the left hemiparesis worsened on May 4, 1992. CT scan revealed an irregular high-density area in the tumor because of intratumoral hemorrhage. After embolization of the arteries feeding the tumor, surgery was performed on May 8, 1992, and the tumor was totally removed. Histological examination of the tumor specimen revealed that it was a metastatic hepatocellular carcinoma. The patient died 8 months after initial diagnosis because of hepatocellular carcinoma.

Aged↗

PubMed1995

[A case of meningioma associated with intracerebral hemorrhage and acute deterioration].

We report a case of convexity meningioma associated with sudden onset of intracerebral hemorrhage followed by acute deterioration. A 76-year-old previously healthy male suddenly collapsed into coma and was admitted to our department. On admission, he was deeply comatose. Computerized tomography (CT) scan revealed intracerebral hemorrhage in the right frontal lobe, together with an isodense mass lesion of about 5 cm in diameter. The density on the fronto-medial side of the mass increased after administration of contrast medium, probably due to extravasation. However, there was no enhancement of the mass lesion. Cerebral angiography revealed marked prolongation in circulation time and extravasation via the right middle internal frontal artery. The right middle meningeal artery was dilated and elongated, but no tumor stain was found. The patient died on the following day. Autopsy disclosed massive hemorrhage in the right frontal lobe together with a convexity meningioma. Histological examination showed that the tumor was a fibroblastic meningioma. We review previously reported cases of convexity meningioma associated with intracranial hemorrhage, and discuss mainly the mechanism of bleeding.

Acute Disease↗

PubMed1995

[A case of multiple cerebral arteriovenous malformations treated by gamma knife radiosurgery].

We reported a case of multiple cerebral arteriovenous malformations (AVMs) treated by gamma knife radiosurgery. A 6-year-old girl was admitted because of systemic tonic convulsion. At the first admission, we performed only vertebral angiography, which showed a 15 mm cerebral AVM. It was fed by the right posterior cerebral artery and drained into the great vein of Galen. Seven years after the first admission, the patient returned again with severe headache. Four-vessel cerebral angiograms showed another 7 mm AVM fed by the left frontopolar artery. We treated both cerebral AVMs bv gamma knife radiosurgery. Follow-up angiograms performed 2 years after radiosurgery confirmed the disappearance of both AVMs. We then discuss treatment of multiple cerebral AVMs.

Abnormalities, Multiple↗

PubMed1994

A case of meningioangiomatosis without von Recklinghausen's disease. Report of a case and review of 13 cases.

Meningioangiomatosis is rare disease and is classified as hamartoma in central neurofibromatosis. Unlike most cases of meningioangiomatosis, the very rare case reported here was not associated with von Recklinghausen's disease. We could find only 12 previous cases reported in the literature. A review was carried out of the clinical features, imaging characteristics, and histopathological findings in those 12 plus ours for a total 13 cases. Several types of convulsion were identified as clinical symptoms in 11 of the 13 cases. They were treated surgically. Prognosis was satisfactory in most cases. Proliferation of small blood vessels accompanied by endothelial cells with glial tissue as background and proliferation of fibroblasts or meningothelial cells in the perivascular space were observed to be the most frequent histopathological features.

Adolescent↗

PubMed1994

Timing of admission and management outcome in patients with subarachnoid hemorrhage.

The purpose of this study is to investigate the overall management outcome in patients with subarachnoid hemorrhage who were admitted in the ultra-early stage. A total of 601 patients with subarachnoid hemorrhage were classified into three groups, that is, those admitted within 6 hours (group 1: 371 cases, 62%), those admitted from 6 hours to day 3 (group 2: 145 cases, 24%) and those admitted from day 4 to 30 (group 3: 85 cases, 14%). The shorter the interval from hemorrhage to admission, the worse were the clinical and subarachnoid hemorrhage grades on admission. The operability rate of group 1 was lower than that of group 2 or 3-62%, 73%, and 71%, respectively. At 6 months the overall outcome of group 1 was significantly poorer than that of group 2 or 3; the mortality rate was 39%, 27%, and 19%, respectively. The poor outcome in group 1 was a result of a worse neurologic state compared with groups 2 and 3. By life-table analysis, the survival curve of group 1 was also significantly poorer than that of group 2 or 3; the 5-year survival probability was 50%, 64%, and 67%, respectively. However, when analyzing the survival curves in patients with admission grades I-III or in those who were operated on, differences among the three groups were insignificant. Regarding age, the long-term survival probability as well as the short-term outcome were definitely inferior in patients aged > or = 70 years, especially in group 1. It is concluded that while the management outcome in patients admitted in the ultra-early stage after subarachnoid hemorrhage was poorer than in those admitted at later stages, if the subjects were restricted to those with good risk or those who underwent surgery, the results were not necessarily poor.

Aged↗

PubMed1994

Complication of silastic dural substitute 20 years after dural plasty.

A 63-year-old woman was admitted because of right hemiparesis. Both computed tomography scan and magnetic resonance imaging revealed a mass lesion in the left parieto-occipital lobe. Twenty years previously, meningioma of the left parieto-occipital region was removed at another hospital, and a dural plasty was performed using a silastic dural substitute. The patient was operated on under the diagnosis of recurrent meningioma. However, most of the mass lesion was composed of an old hematoma, which seemed to be a complication of the silastic dural substitute.

Aged↗

PubMed1994

Ultra-early rebleeding within six hours after aneurysmal rupture.

During 1980-85, cerebral angiography was performed as soon as possible for early operation of ruptured aneurysms. However, during that period, the incidence of rebleeding during angiography conducted within 6 hours after the initial rupture was approximately two-fold higher than the rate of rebleeding within 6 hours for the total series. Therefore, since 1986, patients with grades I-IV have been managed with complete bed rest, and angiography has been withheld during the first 6 hours after rupture, except in patients in whom emergency operation was anticipated. To investigate whether this change of policy has been effective in decreasing ultra-early rebleeding within 6 hours after rupture, patients admitted during 1986-92 were compared with those admitted during 1980-85. Of the total 418 patients who were admitted within 6 hours after initial rupture, 61 (15%) had ultra-early rebleeding: 18 prior to and 43 after admission. The rebleeding rate during angiography within 6 hours after rupture was 7%. In patients with grades I-IV, the percentage of patients receiving angiography within 6 hours after rupture decreased from 45% during 1980-85 to 13% during 1986-92 (p < 0.01), and the ultra-early rebleeding rate decreased from 15% during 1980-85 to 5% during 1986-92 (p < 0.01). However, with the increase in number of patients referred in the ultra-early stage, the number of rebleeding cases during transfer increased. In conclusion, in order to reduce the rate of ultra-early rebleeding, withholding aggressive management such as angiography in this stage seems to be effective, and if there is no need for emergency operation, it is better to withhold patients' transfer in this stage and commence it soon after 6 hours following subarachnoid hemorrhage.

Adult↗

PubMed1993

A case of tinnitus and hearing loss after cerebellar hemorrhage.

BACKGROUND: Approximately 10% of cases of hypertensive intracerebral hemorrhage are cerebellar hemorrhage. We report a case of intracerebellar hemorrhage in which the initial symptoms were hearing loss and tinnitus. SUMMARY OF REPORT: A 45-year-old man suddenly complained of hearing loss and tinnitus on the right side. Computed tomography demonstrated a high-density area 1.2 cm in diameter in the right cerebellar peduncle. Because of enlargement of the high-density area, the patient underwent surgery based on the diagnosis of hypertensive intracerebellar hemorrhage, and the hematoma was evacuated. The right-sided acoustic nerve was remarkably swollen by a subpial hematoma. CONCLUSIONS: In this case, hemorrhage of the right cerebellar peduncle extended to the eighth nerve through the subpial space, causing hearing loss and tinnitus.

Cerebral Hemorrhage↗

PubMed1993

Management outcome in the elderly patient following subarachnoid hemorrhage.

The purpose of this study was to investigate whether the overall management outcome for elderly patients with subarachnoid hemorrhage (SAH), especially for those aged 70 to 79 years, has improved. To this end, the author compared data for the period between 1986 and 1990 (Study Period 2) with those obtained between 1980 and 1985 (Study Period 1). Of 503 patients who were admitted by Day 3 after SAH during the two study periods, 243 (48%) were 59 years of age or younger, 129 (26%) were 60 to 69 years of age, 102 (20%) were 70 to 79 years of age, and 29 (6%) were 80 years of age or older. The percentage of patients aged 70 years or more doubled from 17% during Study Period 1 to 34% during Study Period 2. During Study Period 1, the older patients had a lower operability rate; during Study Period 2, the operability rate for patients aged 70 to 79 years (69%) was similar to that for patients aged 50 to 69 years. At 6 months after SAH for patients aged 70 to 79 years, the overall management and surgical results of good recovery or moderate disability were 18% and 36%, respectively, during Study Period 1, and improved to 41% and 60%, respectively, during Study Period 2. During Study Period 1, the cumulative 5-year survival probabilities for overall management were 58% for patients aged 59 years or less, 53% for those aged 60 to 69 years, and 24% for those aged 70 to 79 years; during Study Period 2, these probabilities improved to 70%, 58%, and 47%, respectively. The 5-year survival rates of surgically treated patients in these three age groups increased from 77%, 68%, and 44% to 88%, 77%, and 69%, respectively.

Aged↗

PubMed1992

Cerebral vasospasm in elderly patients treated by early operation for ruptured intracranial aneurysms.

Cerebral vasospasm in elderly patients was studied under strict criteria. A total of 145 patients, who had been operated on in the acute stage after subarachnoid haemorrhage, were classified into two age groups. Those aged 59 years or younger were in group 1 (76 cases, 52%), and those aged 60 years or older were in group 2 (69 cases, 48%). The severities of both the subarachnoid haemorrhage on computed tomography scan and the angiographic vasospasm were graded from 0 to IV. Close correlations were found in both groups for the angiographic vasospasm grades to the incidences of both symptomatic vasospasm and low-density areas on computed tomography scan. Angiographic vasospasm was observed in 95% of group 1 and in 91% of group 2 patients. The incidences of permanent symptomatic vasospasm were 14% in group 1 and 19% in group 2. Low-density areas on computed tomography occurred in 16% of group 1 and in 17% of group 2. Generally, the higher the clinical grades and/or the higher the subarachnoid haemorrhage grades, the more severe were the vasospasms. These tendencies were more apparent in subarachnoid haemorrhage grading. The mortality rates were 8% in group 1 and 17% in group 2. However, when both the clinical grades and the subarachnoid haemorrhage grades were analyzed, there were no significant differences between groups 1 and 2 in either the severity of vasospasm or in the outcome. It must be concluded that neither the angiographic vasospasm grades nor the incidence of symptomatic vasospasm are significantly effected by age.

Aged↗

PubMed1992

Unruptured intracranial aneurysms in elderly patients.

A total of 556 patients with 769 intracranial aneurysms, of which 256 were unruptured and 513 were ruptured, were included in the present study. The patients were divided into three age groups: those aged 59 years or younger, those aged 60 to 69 years, and those aged 70 years or older. Small aneurysms of 4 mm or less in diameter were more common in the series of unruptured aneurysms than in the ruptured aneurysms. The rupture rate in anterior communicating artery aneurysms was the highest, and it increased with age. A follow-up study was performed on 47 patients with 55 unruptured aneurysms, and only one giant basilar artery aneurysm ruptured during the average follow-up period of 5.2 years. Direct operation was performed on 52 patients with unruptured aneurysms. While the surgical mortality rate was 0%, the morbidity rate was 6% (three of 52 cases), which was not directly related to the patients' age. When considering surgery for unruptured aneurysms, rupture rate of aneurysms at each site is one of the most important factors, especially in elderly patients.

Adult↗

PubMed1992

Effect of temporary pacing on patients with bradycardia in the acute stage following subarachnoid hemorrhage.

In nine cases of bradycardiac arrhythmia of less than 50 bpm that arose during cerebral vasospasm following aneurysmal rupture the patients were treated by temporary pacing. In patients with cerebral vasospasm, in whom autoregulation of the cerebral circulation is impaired, bradycardia aggravates the risk of decreased cerebral blood flow. This study demonstrated that temporary pacing is an effective and safe procedure in maintaining heart rate during vasospasm.

Bradycardia↗

PubMed1991

Effect of continuous cisternal drainage on cerebral vasospasm.

The effect of continuous cisternal drainage on cerebral vasospasm was studied under strict criteria in 140 patients with ruptured intracranial aneurysms. The degree of subarachnoid haemorrhage (SAH) on the computed tomography scan was graded from I to IV. The patients were classified according to the total amount of cisternal drainage into three groups, regardless of the duration of the drainage and whether or not it was accompanied by irrigation; i.e., those with less than 500 mL (group 1: 57 cases), those with 500-3000 mL (group 2: 44 cases), and those with 3000-9500 mL (group 3: 39 cases). While correlations could be found between both clinical and SAH grades with the severity of vasospasm, closer correlation could be found in the SAH grades. In analyzing the cases with subarachnoid haemorrhage grades III-IV (severe clots), the angiographic vasospasm was less severe in groups 2 and 3 than in group 1, and the incidences of permanent symptomatic vasospasm and low-density area on computed tomography were lower in groups 2 and 3 than in group 1. Regarding the surgical outcome in cases with SAH grades III-IV, the mortality rate was lower in groups 2 and 3 (22% and 19%) than in group 1 (33%). Further, the rate of good recovery was higher in groups 2 and 3 (61% and 57%) than in group 1 (28%). However, there were no differences between groups 2 and 3 in cerebral vasospasm or in surgical outcome. As a shortcoming of continuous cisternal drainage, the need for shunt operation was higher in groups 2 and 3 than in group 1.

Adult↗