Radiation-induced cerebral aneurysm successfully treated with endovascular coil embolization.

In a 30-year-old male, multiple cerebral aneurysms developed 19 years after receiving 60 Gy of irradiation for craniophariginoma. Angiogram revealed right IC-PC and upper basilar trunk aneurysms in addition to atherosclerotic change. The right IC-PC aneurysm was wrapped and the basilar trunk aneurysm located between the origins of SCA and AICA was treated by endovascular coil embolization. The packing of the aneurysm was complete, but stenosis of the basilar artery appeared. The patient was discharged uneventfully and follow-up angiogram 6 months later demonstrated that the aneurysm had disappeared and the patency of the basilary artery had been preserved. Radiation-induced intracranial vasculopathy is a well-recognized phenomenon, but aneurysm formation is less common than arterial occlusive lesion. However, the mortality rate after bleeding is so high that immediate diagnosis and treatment by direct surgery or coil embolization are necessary.

Polymorphism in rice amylases at an early stage of seed germination.

A polymorphism in rice amylases at an early stage of seed germination is analyzed by zymogram. In non-glutinous cultivars of rice, alpha-amylase isozymes are mainly confirmed in germinating seeds. However, in glutinous cultivars, beta-amylase isozymes, which are not confirmed in nonglutinous cultivars, make up the major part of the total amylase activity and the expression of alpha-amylases are repressed.

Representation of the ear in human primary somatosensory cortex.

We studied 13 healthy subjects with a multichannel magnetoencephalography (MEG) system to investigate the somatotopic representation of the ear in the primary somatosensory cortex (SI). We stimulated three parts of the left ear: the helix, the lobulus, and the tragus. The somatosensory-evoked magnetic fields (SEFs) were successfully measured in 7 of 13 subjects. Short-latency responses were analyzed using both single dipole and multidipole models (brain electric source analysis, BESA). From the single dipole model, the equivalent current dipole (ECD) following the helix stimulation was estimated to be near the neck area of SI in all the subjects. In the lobulus stimulation, the ECDs were estimated around the neck area of SI in four subjects, in the face area in one subject, and in the deep white matter in two subjects. In the tragus stimulation, the ECDs were estimated around the neck area of SI in three subjects, in the hand area of SI in two subjects, and in the deep white matter in two subjects. When the ECDs were estimated to be located in unlikely sites (hand area and deep white matter), a two-dipole model, (1) the neck area of SI and (2) face area of SI, was found to be the most appropriate. Although this might be a preliminary study due to a relatively small number of subjects, it revealed that receptive fields of some part of the ear, such as the lobulus and tragus, might be present in both the neck and face areas of SI. These findings suggested that the "ear area" of SI has variability between subjects, unlike the other areas of SI, possibly because the ear is located on the border between the neck and face.

Perception of apparent motion is related to the neural activity in the human extrastriate cortex as measured by magnetoencephalography.

To determine the neural correlate of apparent motion perception, we measured magnetic responses to visual stimuli in apparent motion and compared the results with subjective rating of the quality of perceived motion with varied stimulus timing. The latency of the magnetic response was about 150 ms, and its origin was estimated to be in the occipito-parieto-temporal junction. The strength of the first component in the response varied with the stimulus timing, the maximum value being at the interval 0. The change could not be explained by the simple summation of onset and offset responses and this value was related to the subjective rating of quality (smoothness) of motion measured of the stimulus. Results indicate there is a localized cortical region of neural activity which is closely related to the subjective assessment of quality of perceived motion.

Postural adjustment response to depth direction moving patterns produced by virtual reality graphics.

PURPOSE: Human posture is controlled by a combination of vestibular, somatosensory and visual information. This paper is concerned with postural readjustment responses induced by vection. In the visual control of posture, visually-induced perception of self-motion plays an important role and is called vection. Vection is difficult to measure quantitatively because it is a highly subjective phenomenon. HYPOTHESIS: An optokinetic stimulus that moves in depth induces vection. We hypothesize that the magnitude of the visually-induced body sway is correlated with the degree of vection. METHODS: A depth optokinetic stimulus (DOKS) was projected onto a head-mounted display (HMD) worn by standing subjects. The DOKS consisted of a random dot pattern that was perceived three-dimensionally and moved in depth sinusoidally. Vection was estimated in two ways, a verbal assessment and a joystick maneuver. In addition, visually-induced body sway was measured by monitoring five reference points on the body by two video-motion analyzers. RESULTS: The magnitude of the subjective vection was highly correlated with visually-induced body sway and was strongly dependent on the velocity of the visual stimulus. The ankle joint was pivoted during visually-induced body sway and acted as a motion initiator. When the magnitude of body sway was large, the body movement was adjusted at the hip and head-neck joints. CONCLUSIONS: The high correlation between vection and body sway suggests that vection can be estimated quantitatively by measuring visually-induced body sway.

[A case of neurocysticercosis with multiple intraparenchymal and intraventricular cysts].

Neurocysticercosis is a rare disease, and no association with intraventricular cysts has been reported in Japan. We report a case of neurocysticercosis that presented the unique symptom of a fourth ventricular cyst. A 55-year-old man with a 7 year history of neurocysticercosis and hydrocephalus developed a positional headache and vomiting 3 months after an L-P shunt, and was admitted to our hospital. MRI showed multiple intraparenchymal cysts, ventricular enlargement and an intraventricular cyst in the fourth ventricle. The cyst and the cysticercus in the fourth ventricle were totally removed via the suboccipital approach. Histological examination showed characteristics of cysticercus. Two weeks after this surgery, V-P shunt with neuroendoscopical observation of the ventricle was performed. A small cyst was detected in the right lateral ventricle. The symptoms disappeared after surgery. Following surgery, a therapeutic course of albendazole was administered at a daily dose of 600 mg for 30 days. MRI after administration of the anticysticercal drug revealed reduction in the size of the cysts.

Stenting for stenoses of the proximal vertebral artery.

SUMMARY: We report our initial experience of stenting for symptomatic stenoses of the proximal vertebral artery. A total of 25 lesions affecting the proximal vertebral artery were treated by PTA with stent in 23 patients. The lesions involved the vertebral artery ostium in 20 lesions and the nonostial VI portion in five lesions. The mean stenosis rate of those lesions was 81% pre-stenting and was reduced to 4% post-stenting. There were two transient neurological complications: hemiparesis in one patient and visual acuity disturbance in another. Angiographic followup studies more than three months after treatment demonstrated restenosis in three patients. One of these patients was symptomatic. These restenoses were successfully treated by PTA. Our initial results demonstrated that stenting is a feasible and safe method of treating stenosis of the proximal vertebral artery.

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.

Control of upright standing posture during low-frequency linear oscillation.

We examined the effects of anteroposterior movement of a sled on human upright standing. Each of six healthy men stood on the platform of a sled in the dark. The sinusoidal acceleration was provided, from 0.02 to 0.04 G, followed by 0.06 and 0.08 G, at a stroke length from 6 to 10 m and then to 14 m. Low acceleration (0.02 and 0.04 G) induced body sway, pivoting on the ankle joint. High acceleration (0.06 and 0.08 G) increased body sway, but the head-neck joint remained locked upright. The electromyographic recordings of the lower leg muscles revealed continuous tonic EMG activities of the gastrocnemius and tibialis anterior muscles at acceleration of 0.02 and 0.04 G, while reciprocal activation was observed at 0.06 and 0.08 G. During head movement, the neck muscles were slightly activated tonically at acceleration of 0.02 and 0.04 G, but they were markedly and tonically activated at 0.06 and 0.08 G. We speculate that the sled oscillation caused body sway in proportion to the acceleration, with the ankle joint playing a principal role. Analysis of neck movement also revealed that the head was held in a fixed upright position, indicating that the vestibulocollic reflex might tonically activate the neck muscles.

Tissue distribution of pathological lesions and Hu antigen expression in paraneoplastic sensory neuronopathy.

We investigated the distribution of lesions and Hu antigen expression in two autopsied cases of anti-Hu antibody-positive paraneoplastic sensory neuronopathy (carcinomatous subacute sensory neuropathy). Pathological changes in both patients were limited to the primary sensory neurons, some of the sympathetic ganglia and hippocampal regions. The lesions showed a multifocal distribution that differed among the spinal segmental levels and in the individual dorsal root ganglia as well as in the nerve fascicles. Western blot analysis of the patients' serum revealed that Hu antigens were extensively and widely expressed throughout the central nervous system, sensory and sympathetic ganglia and cancer cells, but not in the non-neural visceral tissues. Reverse transcriptase-polymerase chain reaction also showed that the Hu D, Hu C, Hel-N1 and Hel-N2 mRNAs were extensively and widely expressed through the neural tissues and cancer cells, but not in the visceral tissues. Thus, the distribution of antigen expression was very different from that of the lesions. Taken together with the distribution of lesions and Hu antigen expression, it is suggested that factors other than anti-Hu antibodies are also involved in the pathogenesis of this neuronopathy.

Endosaccular embolization for internal carotid artery aneurysms at the c3 portion.

SUMMARY: Direct surgery for the aneurysms at the C3 portion of the internal carotid artery (ICA) requires relatively complicated procedures. We present three patients with this aneurysm who underwent endovascular embolization. The remodelling technique was utilized in two of these patients with unruptured aneurysms. Sufficient obliteration was achieved in every case. Endovascular embolization may be an important alternative for ICA C3 aneurysms.

[Impaired associated movement in Parkinson's disease].

We analyzed the intended voluntary movement and simultaneously occurring automatic associated movement in Parkinson's disease(PD). We studied wrist dorsiflexion as a movement associated with grip and Bell's phenomenon(upward rolling of the eyeballs on forcible closure of the eyelids) in patients with PD and normal controls. The patients showed significantly smaller wrist dorsiflexion and upward rolling of the eyeballs. Patients with PD have a greater reduction of automatic associated movement than intended voluntary movement. This discrepancy between the associated movement and voluntary movement may be one of the bases of clinical symptoms of PD patients in early stage.

[Binocular functions in amblyopia and strabismus].

Regarding the changing trends in the concept, definition, etiological classification, and criteria for diagnosis of amblyopia, we reviewed a total of 4,693 cases of amblyopia seen during the past 37 years. The amblyopia was divided into four types: strabismic, anisometropic, ametropic, and form vision deprivative. There was a definite trend for the incidence to decrease and for the diagnosis to be made during earlier age in recent years. Although favorable recovery of visual acuity is obtained after treatment of amblyopia and strabismus, there are difficulties in obtaining good binocular functions in early-onset amblyopia and strabismus. This feature was evaluated in regard to motion perception asymmetry (MPA) and binocular depth from motion (DFM). Many cases of early-onset amblyopia and strabismus showed no disparity stereopsis, or position stereopsis, in spite of the presence of DFM. The MPA appeared to be closely related to early-onset esotropia regardless of age, while it disappeared and motion perception became symmetric 4 to 5 months after birth in normal infants. The DFM seemed to play an important role in maintaining good motor alignment for several years after surgery. I developed a checkerboard pattern stimulator in 1978. This method proved to be useful in developing binocular functions and motor alignment by applying simultaneous bifoveolar stimulation and anti-suppression. Extensive exposure to the stimulation was essential for therapeutic success.

Effects of linear movements on upright standing position.

This study investigated the effects of antero-posterior movement on the upright standing posture in the humans. Subjects were asked to stand on a platform in a linear accelerator (sled) in the dark. At a fixed distance of sled movements in an antero-posterior direction, peak speed was changed by sinusoidal modes run at 0.02 G, 0.04 G, 0.06 G and 0.08 G. At lower speeds (0.02 G and 0.04 G) joints moved in parallel, but at higher speeds (0.06 G and 0.08 G) the hip flexed or extended in the direction of the sway. At lower speeds (0.02 G and 0.04 G) EMG in lower leg exhibited co-activated patterns in both forward and backward accelerations at lower speeds (0.02 G and 0.04 G), but at higher speeds (0.06 G and 0.08 G) TA was activated with reciprocal inhibition of GC to maintain the body in equilibrium in a reflexive manner. This reciprocal inhibition may be due to main reflex control elicited by motor functions as a result of the linear acceleration. The threshold of speed was assumed to be from 0.04 G to 0.06 G for all but one subject.

[A case of X-linked bulbar and spinal muscular atrophy with impaired neuromuscular transmission].

A 43-year-old man suffered from weakness of the upper limbs and easy fatigability. Low frequency (3 Hz) repetitive nerve stimulation (RNS) showed a marked waning with a maximum decrement of 20% of M wave amplitude. This remarkable waning was partially reduced by an administration of 60 mg bromopyridostigmine. High frequency RNS (30 Hz), however, did not induced waxing. Tensilon test and anti-AchR antibody were negative. The CAG repeat in androgen receptor gene was abnormally expanded ((CAG)n = 47), which confirmed a diagnosis of X-linked bulbar and spinal muscular atrophy. (BSMA). In some ALS patients, impaired neuromuscular transmission has been reported. The impaired neuromuscular transmission in ALS occurs in cases with rapidly progressive muscle wasting, suggesting that this abnormality is related to rapidly degenerating motor nerve endings. However, impaired neuromuscular transmission as seen in this patient has not been well documented in BSMA.

Direct inhibitory effect of neurotensin on isolated gastric smooth muscle cells of guinea pig via the cyclic GMP system.

Smooth muscle cells isolated from the gastric muscle layers of the guinea pig were used to determine whether neurotensin can inhibit the contractile response produced by 10(-6) M carbachol by exerting a direct action on muscle cells. In addition, the inhibitory effect of 2',5'-dideoxyadenosine, an inhibitor of adenylate cyclase, and methylene blue, an inhibitor of guanylate cyclase, on the neurotensin-induced relaxation of gastric smooth muscle cells were examined. Neurotensin inhibited the contractile response produced by carbachol in a dose-dependent manner, with an IC50 value of 5 nM. 2',5'-Dideoxyadenosine did not have any significant effect on the neurotensin-induced relaxation. On the other hand, methylene blue significantly inhibited the relaxation produced by neurotensin. These results strongly suggest that the action of neurotensin is mediated by cyclic GMP.

Direct inhibitory effect of calcitonin gene-related peptide and atrial natriuretic peptide on gastric smooth muscle cells via different mechanisms.

Smooth muscle cells isolated from the gastric muscle layers of the guinea pig were used to determine whether calcitonin gene-related peptide (CGRP) and atrial natriuretic peptide (ANP) can inhibit the contractile response produced by 10(-6) M carbachol by exerting a direct action on muscle cells. In addition, the inhibitory effect of 2', 5'-dideoxyadenosine, an inhibitor of adenylate cyclase, on the CGRP-induced or ANP-induced relaxation of gastric smooth muscle cells were examined. CGRP and ANP inhibited the contractile response produced by carbachol in a dose-dependent manner, and the values of IC50 were 3 nM and 2 nM, respectively. 2',5'-dideoxyadenosine significantly inhibited the relaxation produced by CGRP. On the other hand, 2',5'-dideoxyadenosine did not have any significant effect on the relaxation produced by ANP. These results demonstrate the difference between intracellular mechanism responsible for gastric smooth muscle relaxation by CGRP and the mechanism responsible for muscle relaxation by ANP, and strongly suggest that the action of CGRP is mediated by adenosine 3',5'-cyclic monophosphate.