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Biomedical subjects

W Taki

Publications and source records attributed to W Taki.

At least 55 records · Page 3Linked to original sources
PubMed1999

A cerebrospinal fluid protein associated with moyamoya disease: report of three cases.

OBJECTIVE: The pathogenesis of moyamoya disease is unknown. The purpose of this study was to detect proteins associated with the pathogenesis of moyamoya disease. CLINICAL PRESENTATION: Cerebrospinal fluid (CSF) samples from three patients with moyamoya disease and four control patients who had cervical lesions but no intracranial lesion were studied. INTERVENTION: CSF proteins separated by two-dimensional polyacrylamide gel electrophoresis were analyzed with the SWISS-2DPAGE and SWISS-PROT databases. In the CSF samples from all three patients with moyamoya disease, a polypeptide spot (Mr = 12,000, pI = 5.35) was observed. This spot was not evident in samples from the four control patients and has not been reported in the SWISS-2DPAGE and SWISS-PROT databases. CONCLUSION: A CSF protein, which is possibly novel and associated with moyamoya disease, has been detected. The analysis of CSF by two-dimensional polyacrylamide gel electrophoresis may reveal a clue by which the molecular mechanism of moyamoya disease may be elucidated.

Adolescent↗
PubMed1999

Clonic convulsion caused by epileptic discharges arising from the human supplementary motor area as studied by subdural recording.

In order to help clarify the mechanism of tonic convulsion, which is commonly seen in supplementary motor area (SMA) seizures, we investigated the temporal relationship between ictal discharges arising from the SMA and the associated EMG discharges in the foot, in a patient with SMA seizures, prior to surgical treatment. The patient's intractable seizures consisted of tonic followed by clonic convulsion of the left foot also involving at times, the left hand. Ictal EEGs were investigated by subdural electrodes placed on the SMA-proper and pre-SMA, which were defined by cortical stimulation and by recording cortical-evoked potentials. Interictally, repetitive spike discharges were seen at the pre-SMA. Each seizure initially had a tonic phase associated with an electrodecremental EEG pattern. It was followed by clonic convulsion as shown by clonic EMG discharges of the left tibialis anterior (TA) muscle. It had a duration of 300 to 500 msec, and on each occasion a positive cortical activity at the pre-SMA preceded the EMG onset by 110 msec, and a negative spike at the SMA-proper preceded the EMG onset by 50 to 60 msec. Epileptic discharges originating from the pre-SMA spread to the SMA-proper and possibly also to the primary motor cortex (MI) in this patient. Since both SMA-proper and MI could elicit EMG discharges through the independent corticospinal tracts having different conduction velocities, even a single spike arising from the SMA could give rise to a long EMG burst, which may play some role in the tonic convulsion which characterizes SMA seizures.

Adult↗
PubMed1998

Human supplementary motor area is active in preparation for both voluntary muscle relaxation and contraction: subdural recording of Bereitschaftspotential.

Bereitschaftspotentials (BPs) preceding muscle relaxation and contraction were compared by using subdural electrodes which were implanted onto the right medial frontal surface in two patients with supplementary motor area (SMA) seizure. The applied movement paradigm (muscle relaxation and contraction tasks) was completely the same as employed in our previous study [Terada, K., Ikeda, A., Nagamine, T. and Shibasaki, H., Electroenceph. clin. Neurophysiol., 95 (1995) 335-345]. In both patients, either negative or positive BPs were observed in the SMA-proper and supplementary negative motor area (SNMA) starting at 1.2-1.8 prior to both movements. In one patient, BP was more widespread in the relaxation task whereas more restricted to the hand area in the contraction task. In the other patient, the BPs were observed in the cortical area rostral to SNMA (pre-SMA), in addition to the SMA-proper, in both tasks. It is concluded that SMA-proper and SNMA, and probably pre-SMA as well, in humans are similarly active in preparation for both voluntary muscle contraction and relaxation.

Adult↗
PubMed1998

Cerebral aneurysm associated with persistent primitive olfactory artery aneurysm.

Persistent primitive olfactory artery is a rare vascular anomaly but has a clinical importance because of its high association with cerebral aneurysm. We describe a patient with bilateral persistent primitive olfactory arteries associated with an unruptured saccular aneurysm on the left persistent primitive olfactory artery. Seven reported cases with this anomalous artery including ours are reviewed and classified into two variants. This anomalous artery arises from the terminal portion of the internal carotid artery and courses anteromedially along the ipsilateral olfactory tract and makes a hair-pin curve posterior to the olfactory bulb, becoming the distal anterior cerebral artery (variant 1) or the ethmoidal artery (variant 2). Out of 7 reported cases, 4 cases are associated with saccular aneurysms. The aneurysm in variant 1 is located on the hair-pin curve at which an apparent arterial branch is sometimes absent. Two patients suffer from anosmia. Persistent primitive olfactory artery should be kept in mind because of its high association with intracranial saccular aneurysms and unique clinical presentation.

Arteries↗
PubMed1998

Nonadhesive liquid embolic agent: role of its components in histologic changes in embolized arteries.

RATIONALE AND OBJECTIVES: The authors evaluated the safety and efficacy of a nonadhesive liquid embolic material and the role of its components in histologic changes in embolized arteries. MATERIALS AND METHODS: A Eudragit-E mixture (Rohm Chemische Fabrik, Darmstadt, Germany) was made of a cationic copolymer (Eudragit-E) dissolved in an equal volume of absolute ethanol and iopamidol. The Eudragit-E mixture, an ethanol-iopamidol mixture, and an iopamidol-saline mixture were injected into 12 rabbit renal arteries each. Three rabbits from each group were followed up for 1 day, 1 week, 1 month, and 3 months, at which time they were sacrificed. Kidneys were removed for histologic examination. RESULTS: The Eudragit-E mixture occluded all renal arteries without difficulty: the arteries did not recanalize. Histologically, acute vasculitis was caused by both the Eudragit-E and ethanol-iopamidol mixtures, but not by the iopamidol-saline mixture. Small infarctions were elicited with the ethanol-iopamidol mixture but not with the iopamidol-saline mixture. CONCLUSION: The Eudragit-E mixture is effective and easy to handle. Fifty percent ethanol may play a role in vessel occlusion with Eudragit-E mixture and in acute vasculitis.

Animals↗
PubMed1998

Clinical usefulness of the dipole tracing method for localizing interictal spikes in partial epilepsy.

PURPOSE: To clarify the clinical usefulness of the dipole tracing method in evaluation of interictal EEG spikes in patients with partial epilepsy. METHODS: Eight patients with partial epilepsy were studied. We compared the generator source of interictal spikes detected by the dipole tracing method with the results of magnetic resonance imaging (MRI), interictal/ictal measurement of cerebral blood flow (CBF) by single photon emission computed tomography (SPECT), interictal measurement of glucose metabolism by positron emission tomography (PET) and invasive electrocorticogram (ECoG). RESULTS: In 5 patients with mesial temporal lobe epilepsy (TLE), including 3 patients who underwent standard temporal lobectomy, the dipole tracing method showed results consistent with those of other examinations and better correlation with ECoG than with other noninvasive examinations. In a patient with mesial TLE who had defects in the skull due to previous surgery, the dipoles were located more laterally than expected. In a patient with frontal lobe epilepsy (FLE) who was finally proved to have an epileptogenic area in the lateral frontal area, the spike dipoles were identified in the medial side of the frontal lobe. CONCLUSIONS: The dipole tracing method used in the present study is useful for localizing epileptogenic areas in patients with mesial TLE. However, in patients with partial skull defects and in those with FLE, the reliability of this method is still in accuracy of the lobe level.

Adolescent↗
PubMed1998

Circulatory arrest with profound hypothermia during the surgical treatment of large internal carotid artery aneurysm--case report.

A 43-year-old male presented with a cerebral aneurysm manifesting as right facial paresthesia, without neurological deficit. Angiography revealed a large aneurysm (22 mm) of the left internal carotid artery. Intravascular treatment using placement of a detachable coil was attempted, but the coil did not stay in the aneurysmal cavity and the procedure was abandoned. The patient did not tolerate the transient balloon occlusion test of the left internal carotid artery. Therefore, the aneurysm was clipped through an open craniotomy with profound hypothermia (20 degrees C) with cardiac arrest (24 minutes). The aneurysmal dome was collapsed, allowing easy dissection of the posterior communicating artery. The closed chest method was used during the extracorporeal cardiopulmonary bypass. Postoperative angiography revealed complete neck clipping with preservation of carotid blood flow. The patient recovered well and resumed his employment. Circulatory arrest with hypothermia provides several benefits for the surgical treatment of large and giant aneurysms.

Adult↗
PubMed1998

Large and giant middle to lower basilar trunk aneurysms treated by surgical and interventional neuroradiological methods.

Treatment of large and giant aneurysms of the basilar artery remains difficult and controversial. Three large or giant aneurysms of the lower basilar artery were treated with a combination of surgical and interventional neuroradiological procedures. All patients underwent the balloon occlusion test with hypotensive challenge (blood pressure reduced to 70% of the control value). The third patient did not tolerate the test. In the first patient, both vertebral arteries were occluded through a craniotomy. In the second patient, both the aneurysm and the basilar artery were occluded by detached balloons. In the third patient, one vertebral artery was occluded by surgical clipping and the other by detached helical coils and fiber coils. In spite of anti-coagulation and anti-platelet therapy, postoperative thrombotic or embolic ischemia occurred in the second and third patients. Fibrinolytic therapy promptly corrected the ischemic symptoms, but the second patient developed hemorrhagic complications at the craniotomy area 2 hours later. At follow-up examination, the first patient had only 8th cranial nerve paresis, the second patient who had a hemorrhagic complication was bed-ridden, and the third patient had no deficit. Interventional occlusion requires a longer segment of the parent artery compared to surgical occlusion of the parent artery and might cause occlusion of the perforating arteries. However, selected use of various coils can occlude only a short segment of the parent artery. Thus, the postoperative management of thromboembolic ischemia after the occlusion of the parent artery is easier using the interventional technique.

Adult↗
PubMed1998

Role of transforming growth factor-beta1 in the pathogenesis of moyamoya disease.

OBJECT: Prominent features of moyamoya disease are intimal thickening of the cerebral arterial trunks and abundant angiogenesis for collateral blood supplies, but its pathogenesis is still unknown. The aim of this study was to test the possibility that transforming growth factor-beta1 (TGFbeta1) may play a role in the pathogenesis of moyamoya disease. METHODS: The authors used reverse transcription-polymerase chain reaction to analyze the expression level of TGFbeta1 in smooth-muscle cells cultured from the superficial temporal arteries (STAs) and measured the serum level of TGFbeta1 by using enzyme-linked immunosorbent assay. Although the STA is not predominantly involved with moyamoya disease, it has been used in studies of the pathogenesis of this disease. In this report, the STAs from six patients with moyamoya disease and four with arteriosclerotic cerebrovascular disease, along with sera from 14 patients with moyamoya disease and 10 normal healthy volunteers, were studied. The expression of TGFbeta1 was significantly higher in cultured smooth-muscle cells derived from the STAs of patients with moyamoya disease than in those derived from the STAs of patients with arteriosclerotic cerebrovascular disease (p < 0.05). The serum level of TGFbeta1 was also significantly higher in patients with moyamoya disease than in controls (p < 0.0005). CONCLUSIONS: Taking into account the functional roles of TGFbeta1 in the expression of connective tissue genes and angiogenesis, these investigators suggest that TGFbeta1 is associated with the pathogenesis of moyamoya disease, including abundant neovascularization, although their findings do not necessarily mean that TGFbeta1 is a causative factor in this disease.

Adolescent↗
PubMed1998

[Radical endovascular surgery of a huge cavernous internal carotid artery aneurysm of an aged patient].

A case of a huge aneurysm of the cavernous portion of the internal carotid artery (ICA) is reported. The aneurysm was successfully treated by endovascular surgery. A 78-year-old woman presenting with mild headache and cavernous sinus syndrome on the left side was incidentally disclosed to have a huge aneurysm at the cavernous portion of the left ICA by MRI and MRA. An angiogram revealed that the aneurysm had a broad neck. In view of patient's age, concomitant coronary ischemia and wide aneurysmal neck, endovascular surgery under local anesthesia was thought to be the treatment of choice. The aneurysmal sac was completely embolized with platinum coils and the ICA by a balloon proximal to the aneurysm. Over the 5 months period, the patient's symptoms has all disappeared save for mild abducens palsy. It is believed that neck clipping is the method of treatment of intracranial aneurysms. However, endovascular surgery is less invasive and may be applicable to some of high risk patients.

Aged↗
PubMed1997

Simultaneous recording of epileptiform discharges by MEG and subdural electrodes in temporal lobe epilepsy.

Spontaneous epileptiform discharges were recorded by whole head magnetoencephalography (MEG) and subdural electrodes simultaneously from two patients with medically intractable temporal lobe epilepsy. In one patient whose epileptiform discharges emerged from the lateral temporal lobe, simultaneously recorded MEG could estimate equivalent current dipole reliably near the tumor. The amplitude of the dipole was in proportion not only to the amplitude of epileptiform discharge but also to the number of subdural electrodes involved. In the other patient, MEG detected only a small proportion of epileptiform discharges, even when they were recorded by subdural electrodes from the mesial temporal lobe. It is concluded that the amplitude and the depth of epileptiform discharges would largely affect the sensitivity of dipole localization by MEG.

Adult↗
PubMed1997

Surgical extirpation of the posterior hippocampal arteriovenous malformation.

BACKGROUND: Surgical extirpation of medial temporal (AVMs) arteriovenous malformations has been one of the most challenging issues in neurosurgery. Yaşargil classified mediobasal AVM into four subtypes: amygdala, anterior hippocampal, middle hippocampal, and posterior hippocampal lesions. The lesions around the trigone extending forward to the temporal horn, and medially adjacent to the midbrain, can be referred to as posterior hippocampal AVMs. The therapeutic indications and operative approaches for these lesions remain controversial. METHODS: Nine patients underwent surgical resection for AVMs of the posterior hippocampus using a laterobasal approach. RESULTS: In four patients, AVMs were located chiefly within the lateral ventricle, and the lesions were resected using a laterobasal approach through the occipitotemporal sulcus, or through a hematoma cavity within the fusiform gyrus. Clinical improvement followed the procedure in three of four patients. In the remaining five patients, the nidi were located chiefly within the ambient cistern, extending upward to the basal ganglia. Contralateral hemiparesis occurred in three patients. Two patients showed marked improvement following an initial decline in neurologic status. CONCLUSIONS: A laterobasal transventricular approach is suitable for ventricular AVMs, whereas only limited exposure can be afforded through a transventricular, transchoroidal fissure route for the AVMs within the ambient cistern. For these lesions, a conventional subtemporal approach to the tentorial incisura is preferable.

Adult↗
PubMed1997

Modality-specific organization for cutaneous and proprioceptive sense in human primary sensory cortex studied by chronic epicortical recording.

Modality specificity of human primary somatosensory cortex was studied by recording somatosensory evoked potentials (SEPs) from subdural electrodes in a patient with intractable focal motor seizure. A newly developed device was used for selectively activating proprioception. The spatial and temporal distributions of proprioception-related SEPs elicited by brisk passive flexion movement at the proximal interphalangeal (PIP) joint of the middle finger (4 degrees in 25 ms) were quite different from those to cutaneous sense evoked by electric stimulation of the digital nerve at the same site. It was for the first time demonstrated that proprioception-related SEPs following passive finger movement do not originate in area 3b, which was clearly activated by cutaneous stimulation, and that other sites at the sensorimotor cortex such as areas 2, 3a and 4 possibly contribute to the cortical processing of proprioception.

Adult↗
PubMed1997

Frontopolar ictal epileptiform discharges on scalp electroencephalogram in temporal lobe epilepsy.

We report 3 patients with medically intractable complex partial seizures (CPS) arising from the temporal lobe judged by surgical outcome, in whom scalp electroencephalogram (EEG) showed ictal epileptiform discharges at the frontopolar region. In all patients, results of cranial magnetic resonance imaging (MRI), positron emission tomography (PET), and ictal single photon emission computed tomography (SPECT) were consistent with those of temporal lobe epilepsy (TLE). The epileptogenic area was defined in the temporal lobe by chronic subdural recording in 2 patients. After surgical treatment (amygdalohippocampectomy, anterior temporal lobectomy, and temporal lesionectomy, respectively), all 3 patients became seizure-free and the interictal frontopolar epileptiform discharges on scalp EEG disappeared. Patients with TLE may show ictal scalp EEG with frontopolar onset. This is most likely explained by direction of dipolar orientation of epileptiform discharges in 1 of our patients; rapid spread of ictal activity to the frontopolar area can also be considered in the 2.

Adult↗
PubMed1997

Scalp-recorded, ictal focal DC shift in a patient with tonic seizure.

PURPOSE: We recorded focal ictal DC shifts from scalp electrodes in a 9-year-old boy with intractable, clinically generalized tonic seizures. The patient had a high intensity signal abnormality of the left temporal cortex with thickening of the gyri on T2-weighted MRI. METHODS: Scalp digital EEGs were recorded using electrodes made of silver/silver chloride. The low frequency filter (LFF) was set at 0.016 Hz. Recorded seizures were subsequently analyzed with LFF settings of 1.0, 0.016 and 0.03 Hz. RESULTS: All recorded seizures initially showed diffuse, low voltage, high frequency activity (electrodecremental pattern) followed 10-20 s later by quasirhythmic activity over the left frontotemporal region. In two seizures, LFF of 0.016-0.03 Hz revealed a slow negative shift over the left frontotemporal area simultaneously with onset of the bilateral electrodecremental pattern. However, in the other seizures, this initial slow negative shift was obscured by artifacts. Subsequent electrocorticography (ECoG) delineated frequent epileptiform discharges in the left temporal as well as frontal cortex. CONCLUSIONS: Scalp-recorded ictal DC shifts may help identify focal epileptogenic brain area in patients with clinically generalized seizures although the technique is vulnerable to artifact.

Child↗
PubMed1997

Subdural recording of Bereitschaftspotential is useful for functional mapping of the epileptogenic motor area: a case report.

A 26-year-old man with intractable focal motor seizure beginning with tonic contraction of the left orbicularis oculi muscle had prolonged EEG monitoring with subdural grid electrodes placed over the right perirolandic cortex. Electrical stimulation of the cortex with implanted subdural electrodes showed a relatively low threshold for afterdischarges (ADs) but could not disclose the motor area for the left upper face where or near where the epileptogenic area was expected to be present. Bereitschaftspotential recorded from the subdural electrodes in association with self-paced voluntary blink (eyelid closing) disclosed the motor area specifically related to voluntary movements of the left upper face, which was most likely buried in the sulcus. This observation suggests that recording of Bereitschaftspotential from subdural electrodes is useful for mapping the motor cortex, especially in patients with focal motor seizure with low threshold for ADs to electric stimuli.

Adult↗
PubMed1997

"Cavernous sinus EEG": a new method for the preoperative evaluation of temporal lobe epilepsy.

PURPOSE: In presurgical evaluation of temporal lobe epilepsy (TLE), invasive methods are necessary if results of various noninvasive methods are not sufficiently convergent enough to identify the epileptogenic area accurately. To detect the epileptiform discharges originating specifically from the mesial temporal lobe, we applied the cavernous sinus catheterization technique. METHODS: We placed Seeker Lite-10 guide wire electrodes into bilateral cavernous sinus through the internal jugular veins to record EEG (cavernous sinus EEG) in 6 patients with intractable TLE. Scalp EEG was simultaneously recorded in all 6 and electrocorticogram (ECoG) was also recorded in 4. RESULTS: The cavernous sinus EEG demonstrated clear epileptiform discharges, sometimes even when they were absent on the simultaneously recorded scalp EEG. The epileptiform discharges recorded from the cavernous sinus electrodes were specifically associated with those in the mesial temporal region on ECoG. Ictal EEG pattern originating from mesial temporal lobe was also clearly documented on the cavernous sinus EEG. CONCLUSIONS: This new, semi-invasive method of identifying epileptogenic areas can detect the epileptiform discharges specifically arising from the mesial temporal lobe; it is as useful as or complements the invasive techniques such as foramen ovale or depth recording.

Adolescent↗